PURPOSE: This study aimed to assess long-term follow-up after chemoresection with mitomycin (MMC), a nonsurgical treatment modality for recurrent nonmuscle invasive bladder cancer (NMIBC). At the time of recurrence, chemoresection has previously been shown to reduce the number of patients requiring a procedure (transurethral resection of bladder tumors [TURBT] or office biopsy) by more than 50%. This study investigated the number of patients requiring a procedure during initial treatment and 2-year follow-up in patients treated with short-term, intensive chemoresection with MMC compared with patients undergoing standard surgical treatment of recurrent NMIBC. METHODS: A randomized, controlled trial was conducted in two urological departments in Denmark from January 2018 to August 2021. In total, 120 patients with a history of Ta low- or high-grade NMIBC were included upon recurrence. The intervention group received intravesical MMC (40 mg/40 mL) three times a week for 2 weeks and TURBT or office biopsy only if the response was incomplete. The control group received TURBT or office biopsy and 6 weekly adjuvant instillations. The primary outcome was the number of patients undergoing a procedure within 2 years from inclusion, which was compared between groups using the chi-squared test. Recurrence-free survival was analyzed using the Kaplan-Meier method. RESULTS: Significantly fewer patients were in need of a procedure in the intervention group than in the control group: 71% (95% CI, 57 to 81) and 100% (95% CI, 94 to 100), P < .001. The 12-month recurrence-free survival was 36% (95% CI, 24 to 50) and 43% (95% CI, 30 to 56) in the intervention and control groups, respectively ( P = .5). CONCLUSION: Short-term intensive chemoresection is an effective treatment strategy for recurrent NMIBC that leads to a reduced number of required procedures without compromising long-term oncological safety.

Robot-assisted laparoscopic surgery has gained popularity, which has contributed to a decrease in the number of open procedures. Hence a growing concern regarding the ability of laparoscopically tr...

Currently, no biomarkers of response to mitomycin C have been identified in non–muscle-invasive bladder cancer patients. Predictive biomarkers could improve the treatment outcome and eliminate adverse events from unnecessary treatment. To identify and validate predictive biomarkers of chemoresection with mitomycin C. The intervention group of a randomised controlled trial was identified for analyses. The study was conducted between January 2018 and June 2019 in two major urological departments in Denmark. Patients had a history of Ta low-grade/high-grade disease and were included upon recurrence. The intervention group (58 patients) received chemoresection with mitomycin C. Tumour and reference germline DNA from prior tumours were analysed by whole exome sequencing. Predictive biomarkers were validated in the context of Ta low-grade tumours from the UROMOL study. Response to chemotherapy (intervention group from the randomised controlled trial) and recurrence-free survival (UROMOL cohort) were measured. Groups were compared using Fisher’s exact test and Wilcoxon rank sum test. Chemoresponse was associated with the mutation status of SPTAN1, APC, and FGFR3, and the level of APOBEC signature contribution (p = 0.035, p = 0.034, p = 0.055, and p = 0.035, respectively). The main limitations include no biopsy for biomarker discovery immediately prior to chemoresection and the unmatched validation cohort. Mutation status of APC, SPTAN1, and FGFR3 and the level of mutational contribution from APOBEC-related signatures were identified as potential predictive biomarkers for chemoresection with mitomycin C in non–muscle-invasive bladder cancer patients. A prospective validation study is however needed. We investigated DNA from noninvasive bladder tumours in order to predict treatment response to chemotherapy. Four biomarkers showed promising results, which should be tested in future studies.

Patient-reported outcome measures are increasingly used to assess symptoms, treatment tolerance, and quality of life (QoL) in oncology. Electronic patient-reported outcome measures (ePROM) offer advantages over paper questionnaires, but large-scale evidence using smartphone text messaging in clinical trials is limited. To evaluate the feasibility of collecting ePROM via smartphone text messages in a large-scale, multinational randomized controlled trial of patients receiving Bacillus Calmette-Guérin therapy for non-muscle-invasive bladder cancer. This methodological study was embedded in the North-REG Dwell Time study. During each instillation week, participants received a daily text message linking to a questionnaire assessing side effects. Four additional QoL questionnaires were distributed during the 1-year study period. Non-responders received 2 automated reminders. Patients were randomized into an intervention and control group that differed only in dwell time. All responses were transferred directly into a trial database. Feasibility was assessed by calculating overall response rates and separate response rates for daily side-effect and QoL questionnaires. Between February 2021 and November 2024, 242 participants were enrolled and 225 received at least one instillation. A total of 24,286 text messages were sent, corresponding to 15,485 initially activated questionnaires. The overall response rate was 95%. Response rates were 95% for daily side-effect questionnaires and 87% for QoL questionnaires. No significant differences were found between the intervention and control groups, regarding response rates. Smartphone text messaging is highly feasible for collecting ePROM in a multinational bladder cancer trial, yielding excellent response rates and enabling near real-time symptom monitoring with minimal recall bias.