ISSN 0391-5603 © 2016 Wichtg Publishing UJ Urologia ( 2016; Suppl 2 ): S24-S28 83 REVIEW Both Guidelines of the European Associaton of Urology and American Associaton of Urology for the treatment of low-risk bladder cancer recommend that all patents receive one immediate instllaton of chemotherapy afer transure- thral resecton. The optmal dose and concentraton of this drug remain unknown, and generally, it is administered as a dose of 40 mg in 40 ml of sterile water within 24 hours afer the resecton. In patents with a higher risk of recurrence, further intra- vesical adjuvant treatment is needed, with MMC or Bacillus of Calmete and Guerìn (BCG) according to the risk classifca- ton of recurrence and progression. Even for adjuvant therapy, the optmal dose is stll not well defned, as well as the number of instllaton, but a usual scheme of MMC administraton has remained unchanged over the years: 40 mg in 40 ml of sterile water, one instllaton per week for 4-8 weeks, with a possible maintenance treat- ment (2). Meta-analyses have shown that intravesical chemotherapy reduces the recurrence rate as compared with transurethral bladder resecton (TUR-B) alone (3-5), with a decrease of 8% in the percentage of patents who have recurrence. DOI: 10.5301/uro.5000193 Mitomycin C: new strategies to improve efcacy of a well-known therapy Mauro Ragonese, Marco Racioppi, Pier Francesco Bassi, Luca Di Gianfrancesco, Niccolò Lenci, Alessio Filianot, Salvatore M. Recupero Department of Urology, Agostno Gemelli Hospital, Catholic University Medical School, Rome - Italy Introducton Mitomycin C (MMC) is a chemotherapeutc agent used for intravesical therapy in non-muscle invasive bladder cancer (NMIBC) to reduce the risk of recurrence, which is high in this disease. Given its efcacy and the possibility to use this agent intra- vesically, avoiding the systemic side efects, it is widely used as an adjuvant treatment afer transurethral tumor resecton. It provides valid clinical outcome at the expense of limited local and systemic toxicity given its high molecular weight and its hydrophobicity (1). ABSTRACT Mitomycin C (MMC) as an intravesical chemotherapeutc agent is a well-known opton for treatment of non- muscle invasive bladder cancer (NMIBC) recurrence; it is probably the most commonly used agent given its low rate of side efects and its efcacy. Both the American Urologic Associaton (AUA) and European Associaton of Urology (EAU) consider MMC as a standard treatment for immediate single-dose postoperatve treatment and for adjuvant therapy in low and intermediate-risk NMIBC. Despite the popularity of this agent in the treatment of NMIBCs, many questons regarding the optmal approach to MMC therapy remain unanswered and the schedule widely used is empirical. Nevertheless, even when the current optmal approaches to MMC administraton are used, a large proporton of NMIBCs recur. This apparent treatment resistance might be overcome by an optmizaton of standard MMC therapy or with a combinaton of MMC with other agents that have diferent mechanisms of acton. Strategies to enhance passive delivery of MMC have been well studied and multple measures are recommended for implementaton of use in routne clinical practce. A modifed scheme of instllaton seems to be an easy and inexpensive alternatve to increase efcacy of intravesi- cal MMC and to also use this agent with an ablatve intent. Enhancing tumor response with a sequental therapy is another opton that has been investgated, mostly for chemo-immunotherapy wherein the diferent mechanisms of acton of Bacillus of Calmete and Guerìn (BCG) and MMC are combined to achieve a higher response. Keywords: Combinaton therapy, Intensive treatment, Intravesical therapy, Mitomycin C, Nonmuscle invasive bladder cancer Accepted: August 19, 2016 Published online: October 1, 2016 Corresponding author: Mauro Ragonese, MD A. Gemelli Foundaton Hospital Largo Agostno Vito 1 00168 Roma, Italy mauroragonese@yahoo.it