From the battlefield to the bladder: The development of thioTEPA

Abstract

Effective medications for the treatment of cancer were nonexistent in the early twentieth century. Ironically the widespread use of toxic chemical weapons, chlorine and sulfur mustard gas, during the “Great War” led to the first successful chemotherapeutic treatment of cancer patients. Soon after the introduction of poisonous gas on the battlefield, reports of the resulting pancytopenia in exposed combatants appeared in the medical literature. The biologic effect of chemical weaponry on rapidly dividing cells eventually was recognized for its salutary potential in the treatment of cancer. Once this potential was appreciated, hundreds of similar compounds were synthesized and evaluated as chemotherapeutic agents. One such compound, thioTEPA, would eventually open the era of intravesical treatment of urothelial cancer.

Keywords: ThioTEPA; Bladder cancer; Urothelial cancer; Intravesical chemotherapy; Mustard gas; Mitomycin C

Core tip: We attempt to outline the lineage of intravesical chemotherapy. Specifically, we look at its relationship to poisonous gas used in wartime and chronicle its journey to the bedside.