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The Use of the Electromotive Drug Administration System in Patients with Superficial Bladder Cancer: A Review of the Clinical Effectiveness, Safety, and Cost-Effectiveness

Last updated: September 17, 2014
Project Number: RC0588-000
Product Line: Rapid Response
Research Type: Devices and Systems
Report Type: Summary with Critical Appraisal
Result type: Report

Report in Brief

Context
Superficial bladder cancer refers to the growth of cancer cells in the lining of the bladder wall but not in the bladder muscle. In 2008, this type of cancer accounted for about 6% of all cancers in Canada. Systemic drug delivery ― releasing a drug into the bloodstream ― is generally ineffective in treating this condition because the bladder wall prevents drugs from diffusing into the bladder. Intravesical drug delivery ― delivering a drug through a catheter directly into the bladder ― is more effective but has several limitations, such as the need for repeated infusions. A high recurrence rate coupled with the need for repeated treatments make bladder cancer a costly cancer to treat.

Technology
A new, potential option for treating superficial bladder cancer is electromotive drug administration (EMDA), which delivers drug therapy intravesically using an electrical current. EMDA may also be a cost-effective alternative to the traditional intravesical method. Canadian guidelines on the treatment of bladder cancer issued in 2010 did not provide recommendations for EMDA because there was a lack of evidence at that time.

Issue
A review of the evidence on the efficacy, safety, and cost-effectiveness of EMDA for superficial bladder cancer will help to inform treatment decisions for patients with this condition.

Methods
A limited literature search was conducted of key resources, and titles and abstracts of the retrieved publications were reviewed. Full-text publications were evaluated for final article selection according to predetermined selection criteria (population, intervention, comparator, outcomes, and study designs).

Results
The literature search identified 46 citations, with 7 additional articles identified from other sources. After screening the abstracts, 1 study ― a randomized controlled study ― met the criteria for inclusion in this review.

Key Messages
For the treatment of superficial bladder cancer:

  • Using EMDA to administer mitomycin before performing transurethral resection of the bladder tumour (TURBT) to surgically remove the tumour may be more effective and result in fewer adverse effects than traditional intravesical drug administration of mitomycin after TURBT or than TURBT alone (based on only one study).
  • No information was found on the cost-effectiveness of EMDA.

Question

  1. What is the clinical effectiveness and safety of the electromotive drug administration system in patients with superficial bladder cancer?
  2. What is the cost-effectiveness of the electromotive drug administration system in patients with superficial bladder cancer?

Key Message

There is little evidence on the efficacy and safety of EDMA to treat non-muscle invasive bladder cancer. However the one article included was considered high quality and suggested administrating mitomycin via EDMA prior to transurethral tumour resection (TURBT) results in improved long term outcomes compared to TURBT alone, or passive diffusion of mitomycin post-TURBT. No evidence on the cost effectiveness of EDMA for bladder cancer was identified