Intravesical chemotherapy in the United States. An overview.

Intravesical chemotherapy has been widely employed in this country as part of the treatment strategy for clinically localized bladder cancer. Although surgery remains the principal therapeutic modality, intravesical agents are increasingly being considered as adjuncts and as salvage or prophylactic therapy for polychronotopic superficial disease. Instillation treatment is first-line therapy for diffuse in situ carcinoma. Several compounds have been subjected to intravesical trials in this country, but thio-TEPA has been most extensively studied. More recently mitomycin C and Adriamycin have been utilized following encouraging preliminary reports from abroad. BCG, a biologic agent, has also stimulated interest and current trials. Phase I-II studies with intravesical interferon have been initiated. While the potential role for intravesical therapy is becoming clear, additional trails to test new agents, compare current agents, and refine dose, concentration, volume, and contact time are indicated.