Original Title: Quimiohipertermia intravesical conductiva con mitomicina en el cáncer de vejiga no músculo invasivo: revisión de guías e investigación en marcha

Authors' objectives: To review the consideration or recommendation in Clinical Practice Guidelines on the use of conductive intravesical chemohyperthermia with mitomycin C in patients with non-muscle invasive bladder cancer and to identify ongoing research studies related to this technique

Authors' results and conclusions: Three CPGs (European, Canadian and American) have been identified that refer to chemohyperthermia in the management of non-muscle invasive bladder cancer. The quality of the guidelines, assessed using the AGREE-II instrument, is between 55%-85%, with 70% being considered the minimum value for a guideline to be considered of good methodological quality. None of these guidelines recommend intravesical chemohyperthermia to treat this type of tumour. They all agree that the available scientific evidence for this technique is insufficient and more research trials are needed before incorporating it into their recommendations for use. The guidelines only refer to the results of randomised clinical trials on microwave-induced chemohyperthermia, and do not refer to conductive intravesical chemohyperthermia, which is the subject of this review. Regarding ongoing research studies, only one Spanish study has been identified in the recruitment phase that evaluates the recurrence rate in patients with low-intermediate risk non-muscle invasive bladder cancer using conductive intravesical chemohyperthermia with the COMBAT BRS® system. Conclusions: • The existence of patients refractory to Bacillus Calmette-Guérin treatment and the shortage of Bacillus Calmette-Guérin treatment pose a clinical challenge for the management of patients with NMIBC, especially those at high risk of recurrence and progression. Therefore, in recent years it has been necessary to seek new therapeutic alternatives. Among them, increasing the efficacy of MMC through device-induced hyperthermia has been proposed. There are different techniques to increase the temperature of the chemotherapeutic agent, such as intravesical conductive or recirculating chemohyperthermia using the HIVEC COMBAT BRS® system. • Currently, no Clinical Practice Guideline recommends the use of chemohyperthermia beyond the research setting and they point to the need for further randomised, comparative clinical trials to evaluate its safety and efficacy. • For future research, the limitations of the few clinical trials conducted so far need to be improved: establishing the treatment protocol, comparing the different hyperthermia devices against standard treatment and against each other, and properly categorising the patients to be included.

Authors' methods: A comprehensive literature search was conducted in May 2022 with an update in October 2022, with no time limit, but limited to clinical practice guidelines, in the main bibliographic databases specialised in clinical practice guidelines (CPG), in general databases and on the websites of the main clinical practice guideline development bodies. This information was supplemented by searching for primary studies in databases of ongoing clinical trials. The selection process was peer-reviewed taking into account predefined inclusion criteria. The methodological quality of the guidelines was assessed by peers according to the AGREE-II instrument and the information was extracted from ad hoc tables.

Project Status: Completed

Year Published: 2022

URL for published report: http://hdl.handle.net/20.500.11940/17121

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Spain

Organisation Name: Scientific Advice Unit, avalia-t; The Galician Health Knowledge Agency (ACIS)

Contact Address: Conselleria de Sanidade, Xunta de Galicia, San Lazaro s/n 15781 Santiago de Compostela, Spain. Tel: 34 981 541831; Fax: 34 981 542854;

Contact Name: avalia-t@sergas.es

Contact Email: avalia-t@sergas.es

Copyright: <p>Galician Agency for Health Technology Assessment (AVALIA-T)</p>