Recommended oral sodium bicarbonate administration for urine alkalinization did not affect the concentration of mitomycin-C in non-muscle invasive bladder cancer patients
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Ho Kyung Seo1,2,*, Sung Han Kim1,3,*, Kyung-Ohk Ahn3, Sang-Jin Lee4, Weon Seo Park5, Sohee Kim6, Sang-Hyun Hwang7, Do Hoon Lee8, Jae Young Joung1, Jinsoo Chung1, Jungnam Joo6 and Kyung-Chae Jeong3
1Department of Urology, Center for Prostate Cancer, Hospital, National Cancer Center, Goyang, Gyeonggi-do, Korea
2Biomarker Branch, Research Institute, National Cancer Center, Goyang, Gyeonggi-do, Korea
3Translational Research Branch, Research Institute, National Cancer Center, Goyang, Gyeonggi-do, Korea
4Immunotherapeutics Branch, Research Institute, National Cancer Center, Goyang, Gyeonggi-do, Korea
5Department of Pathology, Center for Prostate Cancer, Hospital, National Cancer Center, Goyang, Gyeonggi-do, Korea
6Biometrics Research Branch, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea
7Department of Laboratory Medicine, Center for Diagnostic Oncology, National Cancer Center, Goyang-si, Korea
8Department of Laboratory Medicine and Hematologic Malignancy Branch, Research Institute and Hospital of National Cancer Center, Goyang-si, Korea
*These authors have contributed equally to this work
Kyung-Chae Jeong, email: firstname.lastname@example.org
Keywords: administration; intravesical therapy; mitomycin C; neoplasm; urinary bladder
Received: March 17, 2017 Accepted: June 30, 2017 Published: October 09, 2017
Objective: Sodium bicarbonate has been reported to maximize the efficacy of intravesical instillation of mitomycin-C (IVI-MMC) therapy by urine alkalinization in non-muscle-invasive bladder cancer (NMIBC). This study aimed to analyze the changes in MMC concentration according to urinary pH and evaluate the efficacy of sodium bicarbonate to maintain the concentration of active form of MMC during IVI-MMC.
Methods: We prospectively enrolled 26 patients with NMIBC after transurethral resection of bladder tumor. Patients with very high-risk and low-risk NMIBC were excluded. Urinary creatinine, volume, pH, and concentrations of MMC and its degraded form were measured immediately before and after IVI-MMC. The patients were administered 1.5 g of oral sodium bicarbonate during the preceding evening, in the morning, and immediately before the fourth cycle of the six-cycle IVI-MMC. The correlation between MMC concentration and urinary pH changes was explored with or without oral bicarbonate therapy.
Results: Recurrence without progression to muscle-invasive disease was noted in 4 of 26 patients in a 23.7-month follow-up. The mean urinary pH before and after the therapy increased from 6.03 to 6.50, and 6.46 to 7.24, without or with oral SB therapy, respectively. Despite this increase, the concentration of active form of MMC did not change significantly. No correlation was found between urinary pH and MMC concentration. Urine alkalinization by SB administration did not maintain the high concentration of urinary MMC.
Conclusions: Urine alkalinization by sodium bicarbonate administration for IVI-MMC did not maintain the high concentration of active urinary MMC in NMIBC.
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