Early Single Instillation Chemotherapy Is Very Beneficial and Should Be the Standard Approach in Non–Muscle-Invasive Bladder Cancer

ContextIt has been demonstrated that an early single instillation of chemotherapy significantly reduces the recurrence rate of patients with non–muscle-invasive bladder cancer (NMIBC); however, the clinical relevance of recurrence reduction has recently been questioned.ObjectiveIn this paper we review the current evidence on the statistical and clinical relevance of an early single instillation of chemotherapy in patients with NMIBC.Evidence acquisitionThis paper was based on a presentation given at the “Early single instillation” session at the 6th Meeting of the European Society of Oncological Urology (ESOU). This presentation was based mainly on review articles dealing with the administration of an early single chemotherapy agent as well as the early or delayed administration of a full chemotherapy scheme in patients with NMIBC.Evidence synthesisAn early single immediate administration, alone or associated with a full chemotherapy scheme, is effective in reducing recurrences in patients at intermediate and high risk for recurrence. Benefits include (1) decreases in requirements for transurethral resection of the bladder (TURB) and in potential complications; (2) a reduction in adjuvant intravesical chemotherapy for all initial patients as well as for patients who need adjuvant therapies after recurrence (in these cases, full intravesical chemotherapy scheme or bacillus Calmette-Guérin (BCG) plus maintenance will be spared); (3) cost savings, as all or the vast majority of recurrent patients need overnight procedures and adjuvant therapies in exchange for nothing or only one more chemotherapy instillation, if BCG was required; and (4) lower anxiety for patients who are likely to develop recurrence.ConclusionsAn early single instillation of chemotherapy reduces TURB requirements, adjuvant therapies, costs, and anxiety, with a minimal increase in toxicity and with slight intensity, if some precautions are taken. It should be considered the standard approach for patients with NMIBC.