In theory, systemic administration of an antineoplastic agent which would be concentrated in the urine and bathe the entire urothelial surface for long intervals offers great promise in the control of superficial bladder cancer. To date, attempts to demonstrate therapeutic efficacy with such agents have met with little success. Limited trials using methotrexate and cisplatin have shown little benefit. Current protocols are evaluating cyclophosphamide and 5-fluorouracil. Chemoprevention with pyridoxine has had one trial with limited benefit. The animal studies use a powerful urothelial carcinogen and maximum tolerated doses of chemotherapeutic agents. In this context, some studies do demonstrate a significant reduction in tumor incidence; however, the differences between control and treatment groups are not uniformly dramatic.
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