Intermittent intravesical
doxorubicin chemotherapy was given to 27 patients with multiple recurrent superficial
transitional cell carcinoma of the bladder, including 12 who had become refractory to intravesical
thiotepa. The starting dose was 60 mg.
doxorubicin diluted in 40 to 50 ml.
normal saline solution and doses were increased to 90 mg. The duration of instillation was 60 minutes. Treatments were administered every 3 weeks for a total of 8 doses, then every 6 weeks for 2 doses and then every 12 weeks for 2 doses.
Therapy then ended for patients who were rendered free of disease. Cystoscopy and urinary cytology studies were performed every 3 months throughout the study. Of the patients 30 per cent had intermittent episodes of
dysuria, 26 per cent had urinary frequency, 41 per cent had
hematuria and 15 per cent had bladder
spasms. None of these toxicities required discontinuation of the
drug. Analysis of plasma samples for
doxorubicin and metabolites revealed no systemic absorption and there was no myelosuppression. Of the 27 patients 15 (56 per cent) have maintained complete eradication of
bladder cancer without any evidence of residual
carcinoma detected endoscopically or with urinary cytology. Recurrent disease developed in 9 patients (33 per cent) while on
therapy, including 3 with muscle invasion. Cystoscopy has remained grossly negative in 3 patients who have had positive class 5 cytology studies. The median duration of followup in all patients has been 12 months, with a range of 6 to 24 months. We conclude that intravesical
doxorubicin is tolerated well and is effective in the management of multiple recurrent superficial
transitional cell carcinoma of the bladder.