Assessment of the oncological outcomes of three different bacillus Calmette–Guérin strains in patients with high-grade T1 non-muscle-invasive bladder cancer

Abstract

Objective: : To determine whether there are significant differences in oncological outcomes between three different bacillus Calmette-Guérin (BCG) strains used for adjuvant intravesical immunotherapy in patients with high-grade T1 (T1HG) non-muscle-invasive bladder cancer (NMIBC). Patients and methods: : Data of 590 patients with a diagnosis of primary T1HG NMIBC were retrospectively reviewed. The study included 138 (23.4%) patients who were treated with the Moreau, 272 (46.1%) with the TICE, and 180 (30.5%) with the RIVM strains. All patients included in the analysis received at least five instillations of an induction course and at least two installations of a maintenance course. Due to existing differences in baseline patient characteristics, the association between oncological outcomes and strain groups was investigated by complementary analysis with the implementation of inverse probability weighting (IPW). Results: : The 5-year recurrence-free survival (RFS) rate was 70.5%, 66.7% and 55.2% for the Moreau, TICE and RIVM groups, respectively (P = 0.016). The 5-year progression-free survival (PFS) rates were 84.4%, 85% and 77.8% in the Moreau, TICE and RIVM groups, respectively (P = 0.215). The IPW-adjusted Cox proportional hazard regression analysis did not show any differences in RFS between the Moreau and TICE groups (P = 0.69), whereas the RIVM strain was significantly associated with worse RFS compared to the Moreau (hazard ratio [HR] 1.69 for RIVM; P = 0.034) and TICE (HR 1.87 for RIVM; P = 0.002) strains. The IPW-adjusted analysis did not show any significant differences between study groups in terms of PFS. Conclusions: : The results of the present study suggest that the Moreau and TICE strains might be superior to the RIVM strain in terms of RFS in patients with T1HG NMIBC.

Combined Modality Bladder-Sparing Therapy for Muscle-Invasive Bladder Cancer: How (Should) We Do It? A Narrative Review

“…Data from these studies emphasize that response rates to BCG therapy were similar to those seen in primary tumors [ 63 , 73 , 74 , 75 ]. Interestingly, although not yet studied in post-CMT patients, various BCG strains were found to perform differently in high-risk NMIBC, with several studies showing the superiority of the BCG-TICE strain over RIVM [ 76 , 77 ]. Despite adequate BCG exposure, Weiss et al reported that 33% of patients had further NMIBC recurrences and 19% progressed to MIBC, respectively [ 75 ].…”

Efficacy of Different Bacillus of Calmette-Guérin (BCG) Strains on Recurrence Rates among Intermediate/High-Risk Non-Muscle Invasive Bladder Cancers (NMIBCs): Single-Arm Study Systematic Review, Cumulative and Network Meta-Analysis

“…Sixty-two studies [ 2 , 3 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76...…”

“…The vast majority of the studies (n = 34, [ 24 , 25 , 26 , 27 , 28 , 29 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 48 , 50 , 51 , 53 , 55 , 56 , 60 , 62 , 63 , 65 , 68 , 69 , 71 , 75 , 76 , 77 , 79 , 80 , 81 ]) were single-arm with no direct comparison across other strains. On the contrary, the remaining n = 27 [ 2 , 3 , 23 , 30 , 31 , 32 , 33 , 43 , 44 , 45 , 47 , 49 , 52 , 54 , 57 , 58 , 59 , 61 , 64 , 66 , …”

“…Additionally, out of the prospective series, n = 12 were head-to-head randomized controlled comparisons yet not primarily focused on strain comparison but rather assessing differences in BCG maintenance schedule (n = 7, [ 2 , 44 , 45 , 47 , 52 , 64 , 82 ]), dose (n = 4, [ 3 , 23 , 54 , 74 ]) or additional related adjuvant therapies (n = 1), [ 72 ]). Retrospective series were in total n = 21 [ 30 , 31 , 32 , 33 , 59 , 61 , 63 , 66 , 77 , 78 , 81 ], accounting for a consistently larger median sample (from n = 27 to n = 1142) and investigating all the multi-treatments BCG comparisons (n = 5, [ 30 , 32 , 33 , 59 , 78 ]). Finally, the systematic review included worldwide experiences, with the vast majority of the studies deriving from Europe (n = 20), followed by Japan (n = 12) and the USA (n = 8), while in several cases (n = 12) there a multicenter design was implemented with no primary institution contribution detectable ( Table 1 ).…”

Compared Efficacy of Adjuvant Intravesical BCG-TICE vs. BCG-RIVM for High-Risk Non-Muscle Invasive Bladder Cancer (NMIBC): A Propensity Score Matched Analysis

“…In their original series, Krajewski et al [24] reported similar findings with the current analysis concerning both TICE and RIVM (5yr-RFS TICE : 61.1% and RFS RIVM : 60.5%). More interestingly, in a recently released multicentric comparative series of three strains (Moreau, TICE, and RIVM), Nowak et al were able to identify how RIVM strain was significantly associated with inferior RFS compared to the Moreau (hazard ratio [HR] 1.69 for RIVM; p = 0.034) and TICE (HR 1.87 for RIVM; p = 0.002) strains [25]; however, no significant differences in PFS were observed among any of the strains. D'Andrea et al [26] published a previous cohort study, which analyzed a retrospective head-to-head cohort of patients allocated to BCG TICE and Moreau, respectively.…”