(1) Background: Intravesical chemotherapy is the standard of care in intermediate-risk non-muscleinvasive bladder cancer (NMIBC). Different agents are used across the world based on availability, cost, and practice patterns.
Epirubicin (EPI), one of these agents, has been used by many centers over many decades. However, its true differential efficacy compared to other agents and its tolerability are still poorly reported. We aimed to assess the differential efficacy and safety of intravesical EPI in NMIBC patients. (2) Methods: This study aimed to systematically review the efficacy and safety profile of Epirubicin (EPI) in the management of non-muscle invasive bladder cancer (NMIBC) compared to other adjuvant therapies. A systematic search of the PUBMED, Web of Science, clinicaltrials.gov, and Google Scholar databases was conducted on 31 December 2023, using relevant terms related to EPI, bladder cancer, and NMIBC. The inclusion criteria targeted studies that evaluated patients treated with EPI following the transurethral resection of bladder tumors (TURBT) for NMIBC and compared oncological outcomes such as recurrence and progression with other adjuvant therapies, including Mitomycin C (MMC), Gemcitabine (GEM), and Bacillus Calmette-Guérin (BCG). Additionally, studies investigating the safety profile of EPI administered intravesically at room temperature and under hyperthermia, as well as oncological outcomes associated with hyperthermic intravesical EPI administration, were included. (3) Results: Eleven studies reported adverse events after adjuvant intravesical instillations with EPI; the most frequently reported adverse events included cystitis (34%), dysuria, pollakiuria, hematuria, bladder irritation/spasms, fever, nausea and vomiting, and generalized skin rash (2.3%). Nine studies compared EPI to BCG in terms of recurrence and progression rates; BCG instillations showed a lower recurrence rate compared to EPI, with limited or non-significant differences in progression rates. Two studies found no significant differences between EPI and MMC regarding progression and recurrence rates. One study showed statistically significant lower recurrence and progression rates with GEM in high-risk NMIBC patients. Another study found no significant differences between EPI and GEM regarding recurrence and progression. (4) Conclusions: EPI exhibits similar oncological performances to Gemcitabine and Mitomycin C currently used for adjuvant therapy in NMIBC. Novel delivery mechanisms such as hyperthermia are interesting newcomers.
Journal of clinical medicine. 2024 Jun 27*** epublish ***
Sever Chiujdea, Matteo Ferro, Mihai Dorin Vartolomei, Giuseppe Lucarelli, Kensuke Bekku, Akihiro Matsukawa, Mehdi Kardoust Parizi, Jakob Klemm, Ichiro Tsuboi, Tamas Fazekas, Stefano Mancon, Shahrokh F Shariat
Doctoral School, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, 540142 Târgu Mureș, Romania., Department of Precision and Regenerative Medicine and Ionian Area Urology, Andrology and Kidney Transplantation Unit, 70124 Bari, Italy., Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan., Department of Urology, Jikei University School of Medicine, Tokyo 143-8541, Japan., Department of Urology, Shariati Hospital, Tehran University of Medical Sciences, Tehran 14878-92855, Iran., Department of Urology, University Medical Center Hamburg-Eppendorf, 20359 Hamburg, Germany., Department of Urology, Shimane University Faculty of Medicine, Shimane 693-8501, Japan., Department of Urology, Semmelweis University, 1085 Budapest, Hungary., Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Italy., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria.