Intravesical bacillus Calmette-Guérin versus chemohyperthermia for high-risk non-muscle-invasive bladder cancer

Introduction: Patients with high-risk non-muscle invasive bladder cancer (NMIBC) need adjuvant intravesical treatment after surgery. Although bacillus Calmette-Guérin (BCG) is highly effective, new adjuvant treatments to decrease recurrences and toxicity have been studies. We performed a retrospective propensity score-matched study to compare the efficacy of BCG and chemohyperthermia (C-HT).Methods: We included 1937 patients diagnosed with bladder cancer between January 2004 and January 2014. The primary efficacy endpoint was recurrence-free interval. Patients treated with C-HT were matched with patients treated with BCG using propensity score- matched analysis. Cox-regression models were used to estimate the association between intravesical treatments and the presence of recurrence and progression.Results: Of the 710 patients treated with intravesical treatments, 40 and 142 were eligible for inclusion in C-HT and BCG groups, respectively. Following case matching, there were no differences in patient or tumour characteristics between treatment groups. The 2-year recurrence-free interval in C-HT and BCG groups were 76.2% and 93.9%, respectively (p = 0.020). C-HT treatment (hazard ratio [HR] 5.42; 95% confidence interval [CI] 1.11–26.43; p = 0.036) and high-grade tumour (HR 4.60; 95% CI 1.01–20.88; p = 0.048) are associated with an elevated odds of tumour recurrence. In multivariate Cox-regression analysis, there was no significant difference between C-HT and BCG in the odds of recurrence (p = 0.054). There were no differences in progression between C-HT and BCG.Conclusion: C-HT is not as effective treatment as BCG in high-risk NMIBC patients who are BCG-naive. Although, there were no significant difference in the odds of recurrence, recurrence-free interval is significantly improved by the administration of BCG.

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Second transurethral resection for high-risk non-muscle invasive bladder cancer patients: a propensity score matched analysis

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyaa041 ◽

2020 ◽

Vol 50 (6) ◽

pp. 718-721

Author(s):

Yuto Matsushita ◽

Kyohei Watanabe ◽

Hiromitsu Watanabe ◽

Keita Tamura ◽

Daisuke Motoyama ◽

...

Keyword(s):

Bladder Cancer ◽

High Risk ◽

Propensity Score ◽

Cancer Patients ◽

Transurethral Resection ◽

Prognostic Significance ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Significant Difference ◽

Muscle Invasive

Abstract Objectives Second transurethral resection is recommended for patients diagnosed with high-risk non-muscle invasive bladder cancer; however, there have been several studies showing conflicting findings regarding the advantage of second transurethral resection. The objective of this study was to investigate the prognostic significance of second transurethral resection using propensity score matched analysis. Patients and Methods This study retrospectively included 164 consecutive patients who underwent initial transurethral resection and were diagnosed with high-risk non-muscle invasive bladder cancer. Of these, 56 subsequently received second transurethral resection, and the remaining 108 underwent initial transurethral resection alone. Results After adjusting patient variables by propensity score matching, 44 patients were included in each group. There was no significant difference in recurrence-free, progression-free or overall survival between these two groups. Conclusions These findings suggested no significant impact of second transurethral resection on the prognosis of high-risk non-muscle invasive bladder cancer patients; therefore, it may be necessary to perform a reassessment focusing on the indication for second transurethral resection by conducting a large-scale prospective study.

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Partial Versus Complete Bacillus Calmette-Guérin Intravesical Therapy and Bladder Cancer Outcomes in High-risk Non–muscle-invasive Bladder Cancer: Is NIMBUS the Full Story?

European Urology Open Science ◽

10.1016/j.euros.2021.01.009 ◽

2021 ◽

Vol 26 ◽

pp. 35-43

Author(s):

Michael E. Rezaee ◽

A. Aziz Ould Ismail ◽

Chiamaka L. Okorie ◽

John D. Seigne ◽

Kristine E. Lynch ◽

...

Keyword(s):

Bladder Cancer ◽

High Risk ◽

Invasive Bladder Cancer ◽

Intravesical Therapy ◽

Bacillus Calmette Guerin ◽

Cancer Outcomes ◽

Muscle Invasive Bladder Cancer ◽

Muscle Invasive

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Non-maintenance intravesical Bacillus Calmette–Guérin induction therapy with eight doses in patients with high- or highest-risk non-muscle invasive bladder cancer: a retrospective non-randomized comparative study

BMC Cancer ◽

10.1186/s12885-021-07966-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Makito Miyake ◽

◽

Kota Iida ◽

Nobutaka Nishimura ◽

Tatsuki Miyamoto ◽

...

Keyword(s):

Bladder Cancer ◽

Propensity Score ◽

Invasive Bladder Cancer ◽

Rank Test ◽

Bacillus Calmette Guerin ◽

Muscle Invasive Bladder Cancer ◽

Free Survival ◽

Landmark Analyses ◽

Muscle Invasive ◽

Group B

Abstract Background To explore possible solutions to overcome chronic Bacillus Calmette–Guérin (BCG) shortage affecting seriously the management of non-muscle invasive bladder cancer (NMIBC) in Europe and throughout the world, we investigated whether non-maintenance eight-dose induction BCG (iBCG) was comparable to six-dose iBCG plus maintenance BCG (mBCG). Methods This observational study evaluated 2669 patients with high- or highest-risk NMIBC who treated with iBCG with or without mBCG during 2000–2019. The patients were classified into five groups according to treatment pattern: 874 (33%) received non-maintenance six-dose iBCG (Group A), 405 (15%) received six-dose iBCG plus mBCG (Group B), 1189 (44%) received non-maintenance seven−/eight-dose iBCG (Group C), 60 (2.2%) received seven−/eight-dose iBCG plus mBCG, and 141 (5.3%) received only ≤5-dose iBCG. Recurrence-free survival (RFS), progression-free survival, and cancer-specific survival were estimated and compared using Kaplan–Meier analysis and the log-rank test, respectively. Propensity score-based one-to-one matching was performed using a multivariable logistic regression model based on covariates to obtain balanced groups. To eliminate possible immortal bias, 6-, 12-, 18-, and 24-month conditional landmark analyses of RFS were performed. Results RFS comparison confirmed that mBCG yielded significant benefit following six-dose iBCG (Group B) in recurrence risk reduction compared to iBCG alone (groups A and C) before (P < 0.001 and P = 0.0016, respectively) and after propensity score matching (P = 0.001 and P = 0.0074, respectively). Propensity score-matched sequential landmark analyses revealed no significant differences between groups B and C at 12, 18, and 24 months, whereas landmark analyses at 6 and 12 months showed a benefit of mBCG following six-dose iBCG compared to non-maintenance six-dose iBCG (P = 0.0055 and P = 0.032, respectively). There were no significant differences in the risks of progression and cancer-specific death in all comparisons of the matched cohorts. Conclusions Although non-maintenance eight-dose iBCG was inferior to six-dose iBCG plus mBCG, the former might be an alternative remedy in the BCG shortage era. To overcome this challenge, further investigation is warranted to confirm the real clinical value of non-maintenance eight-dose iBCG.

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