Mitomycin for intravesical treatment of low-grade intermediate-risk non-muscle invasive bladder cancer

Intravesical mitomycin C (MMC) is a cornerstone therapy for non-muscle-invasive bladder cancer (NMIBC), effectively reducing recurrence in low-grade intermediate-risk patients. We conducted a narrative synthesis of randomized and prospective studies evaluating intravesical MMC across three clinical settings: single immediate post-transurethral resection of bladder tumor (TURBT) instillation, adjuvant multiple instillations, and chemoablation in low- and intermediate-risk NMIBC. Single immediate instillation after uncomplicated TURBT effectively reduces early recurrences in low-risk NMIBC. In intermediate-risk patients, available evidence indicates that adjuvant MMC reduces recurrence by 30-50% versus TURBT alone, with recurrence-free survival gains of 20-35% and minimal systemic toxicity; maintenance cycles further enhance durability when consistently administered. Device-assisted strategies, may further improve recurrence control. For selected patients, MMC-based chemoablation offers a non-surgical outpatient option with encouraging tumor response rates. MMC offers a favorable balance of oncologic efficacy, safety, and logistical feasibility. Evidence supports routine post-TURBT use in low-risk disease, adjuvant benefit in intermediate-risk patients, and emerging chemoablation for selected recurrences, reinforcing MMC as a reliable, accessible component of modern NMIBC management.

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Publication Details

Journal
Future Oncology
Published
2026-04-27
DOI
https://doi.org/10.1080/14796694.2026.2661768
Primary Topic
Bladder and Urothelial Cancer Treatments
Type
article
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article

Mitomycin for intravesical treatment of low-grade intermediate-risk non-muscle invasive bladder cancer

Élisabeth Grobet-Jeandin, Ludovica Cella, J. Caño Velasco, Andrea Gallioli et al.
Future Oncology
Bladder and Urothelial Cancer Treatments
article

Mitomycin for intravesical treatment of low-grade intermediate-risk non-muscle invasive bladder cancer

Élisabeth Grobet-Jeandin, Ludovica Cella, J. Caño Velasco, Andrea Gallioli, Benjamin Pradere, Francesco Del Giudice, Francesco Claps, Ekaterina Laukhtina, Sisto Perdonà, Francesco Soria, Marco Moschini, Luca Afferi, Urothelial Carcinoma Working Group on behalf of the European Association of Urology - Young Academic Urologists (EAU-YAU), Marco Paciotti, Aleksander Ślusarczyk, Andrea Mari, Rodolfo Hurle, José Daniel Subiela, Wojciech Krajewski, Laura S. Mertens, Gautier Marcq, Matteo Ferro, Simone Albisinni, Roberto Contieri, Alessio Finocchiaro
article en

Abstract

Intravesical mitomycin C (MMC) is a cornerstone therapy for non-muscle-invasive bladder cancer (NMIBC), effectively reducing recurrence in low-grade intermediate-risk patients. We conducted a narrative synthesis of randomized and prospective studies evaluating intravesical MMC across three clinical settings: single immediate post-transurethral resection of bladder tumor (TURBT) instillation, adjuvant multiple instillations, and chemoablation in low- and intermediate-risk NMIBC. Single immediate instillation after uncomplicated TURBT effectively reduces early recurrences in low-risk NMIBC. In intermediate-risk patients, available evidence indicates that adjuvant MMC reduces recurrence by 30-50% versus TURBT alone, with recurrence-free survival gains of 20-35% and minimal systemic toxicity; maintenance cycles further enhance durability when consistently administered. Device-assisted strategies, may further improve recurrence control. For selected patients, MMC-based chemoablation offers a non-surgical outpatient option with encouraging tumor response rates. MMC offers a favorable balance of oncologic efficacy, safety, and logistical feasibility. Evidence supports routine post-TURBT use in low-risk disease, adjuvant benefit in intermediate-risk patients, and emerging chemoablation for selected recurrences, reinforcing MMC as a reliable, accessible component of modern NMIBC management.

Future OncologyVol. 22(11)
University of Rome Tor Vergata (IT), Humanitas University (IT), Vita-Salute San Raffaele University (IT), University of Milan (IT), Universidad de Alcalá (ES), Medical University of Warsaw (PL), Policlinico Umberto I (IT), Hospital de Sant Pau (ES), The Netherlands Cancer Institute (NL), Wroclaw Medical University (PL), Hôpital de la Croix-Rousse (FR), Istituto Oncologico Veneto (IT), Azienda Ospedaliero-Universitaria Careggi (IT), IRCCS Ospedale San Raffaele (IT), Clinica Universidad de Navarra (ES), Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale" (IT), Puigvert Foundation (ES), Hôpital Claude Huriez (FR), Kantonsspital Aarau (CH), IRCCS Humanitas Research Hospital (IT), Institut de Recerca Sant Pau (ES), University of Florence (IT), Geneva College (US), Medical University of Vienna (AT)
Good health and well-being
Openalex Percentile: Top 21%
Bladder and Urothelial Cancer Treatments
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