Dose, duration and strain of bacillus Calmette–Guerin in the treatment of nonmuscle invasive bladder cancer

Yongjun, Quan; Jeong, Chang Wook; Kwak, Cheol; Kim, Hyeon Hoe; Kim, Hyung Suk; Ku, Ja Hyeon

doi:10.1097/md.0000000000008300

Cited by 32 publications

(33 citation statements)

References 45 publications

(89 reference statements)

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“…In previous studies, dose and maintenance therapy of intravesical BCG treatment resulted in significant benefits in reducing the recurrence rate after TURBT. However, there were no significant differences in other oncologic outcomes such as PFS, OS and cancer-specific survival (CSS)[15, 18, 19] similar to our study results. BCG maintenance treatment was significantly associated with RFS, although the patients were different.…”

Section: Discussionsupporting

confidence: 86%

“…In univariate and multivariate analyses of risk factors for RFS, the BCG maintenance therapy (HR 0.278, IQR 0.091–0.849, P = 0.050) was the only significant factor (Table 2). Although repeat TURBT patients were not included in the study, RCTs reported differences in prognosis according to BCG duration[15]. Clinical trials of SWOG reported a significantly better prognosis in the maintenance group compared with the control group only with induction.…”

Section: Discussionmentioning

confidence: 99%

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Should intravesical Bacillus Calmette–Guerin (BCG) treatment be administered to patients with T0 after repeat transurethral resection of bladder tumor in patients with high-risk non-muscle invasive bladder cancer?

et al. 2018

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We evaluated the effect of intravesical Bacillus Calmette–Guerin (BCG) and BCG maintenance therapy on the prognosis of patients with T0 after repeat transurethral resection of bladder mass (TURBT). This retrospective analysis involved 427 patients who underwent repeat TURBT within 6 weeks after initial TURBT from 2007 to 2016. Repeat TURBT was performed in patients with high-risk criteria. Patients who achieved T0 after repeat TURBT did or did not receive intravesical BCG therapy. Patients were divided into three groups: non-BCG, BCG induction, and BCG maintenance groups. The study included 106 patients who achieved T0 after repeat TURBT. The median follow-up was 63 months. There were no significant differences in T stage among the three groups. High grade ratio (p = 0.001) and concomitant CIS ratio (p = 0.037) were significantly higher in the BCG maintenance than in the other two groups. The recurrence rates in the non-BCG, BCG induction, and BCG maintenance groups were 46.2%, 28.3%, and 19.2%, respectively (p = 0.043). Recurrence-free survival was significantly higher in the BCG maintenance group than in the BCG induction group (p = 0.032). Progression-free survival was also higher in the BCG maintenance group than in the BCG induction group, but the difference was not significant (p = 0.056). Multivariate Cox regression analysis showed that only intravesical BCG maintenance therapy was significantly associated with recurrence (hazard ratio 0.016, p = 0.016). In high risk NMIBC patients, intravesical BCG maintenance treatment is required even at T0 after repeat TURBT. Intravesical BCG maintenance therapy of patients with T0 after TURBT reduces recurrence.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Should intravesical Bacillus Calmette–Guerin (BCG) treatment be administered to patients with T0 after repeat transurethral resection of bladder tumor in patients with high-risk non-muscle invasive bladder cancer?

et al. 2018

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“…In this study, MT was performed with a half dose of the Tokyo strain and was continued in 2-week cycles. Data regarding this regimen are extremely limited, even in the era of a BCG shortage [3,[9][10][11]. We retrospectively investigated the efficacy and safety of MT with LD-BCG for patients following TURBT for intermediate-to-highrisk NMIBC.…”

Section: Discussionmentioning

confidence: 99%

Impact of maintenance therapy using a half dose of the bacillus Calmette–Guérin Tokyo strain on recurrence of intermediate and high-risk nonmuscle invasive bladder cancer: a retrospective single-center study

Koguchi¹,

Matsumoto²,

Hirayama³

et al. 2020

BMC Urol

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Background Data are scarce regarding intravesical maintenance therapy (MT) with the low-dose bacillus Calmette–Guérin (BCG) Tokyo strain. We investigated the efficacy and safety of MT with a half dose of the Tokyo strain for patients following transurethral resection of nonmuscle invasive bladder cancer (NMIBC). Methods This study retrospectively reviewed clinical data on 78 patients diagnosed with intermediate or high-risk NMIBC followed by either MT (n = 38) or IT alone (n = 40) between January 2012 and March 2018. Statistical analysis was performed to compare recurrence-free survival (RFS) and adverse effects between the two groups. BCG was instilled once weekly for 6 weeks as IT, then once weekly in 2-week for a total of 20 instillations over 3 years. Results Kaplan–Meier analyses showed that patients undergoing MT had significantly better RFS than did those undergoing IT alone (hazard ratio (HR):0.32, 95% confidence interval (CI):0.12–0.89, P = 0.02). The 3-year RFS was 65.0% in the IT group and 89.5% in the MT group. Multivariate analysis showed that MT was associated with a reduced risk of recurrence (HR: 0.32, 95% CI:0.11–0.93, P = 0.03). One MT patient (2.6%) exhibited progression. Conclusions The BCG Tokyo strain showed acceptable efficacy and safety in patients undergoing MT; thus, it is a potential treatment for preventing bladder cancer recurrence.

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“…IVIT is now a standard treatment [1,[18][19][20] after TUR for T1 tumours but was not established as the primary management in the present early series and such a treatment might have improved our recurrence rate. Intravesical BCG is reported to have an impact on progression by some authors [21] and not to have an impact on progression by others [22,23]. In the present study, IVIT had a strong impact on progression, but in patients with low RV or RTV compared to those with high RV or RTV progression rates were similar with or without BCG, and therefore all patients were included in the analysis irrespective of BCG treatment.…”

Section: The Quality Of the Primary Resectionmentioning

confidence: 44%

The Resected Tumour Volume of the Specimen as a Marker of the Quality of the Transurethral Resection in T1 Urinary Bladder Cancer

Jahnson¹,

Olsson²

2019

Int J Cancer Clin Res

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Objective: To study the resected volume (RV) and the resected tumour volume (RTV) in the microscopic examination of the TUR specimen in relation to tumour size, clinical variables and outcome. Materials and methods: This prospectively performed population-based study included all patients in the Southeast Healthcare Region in Sweden with T1 UBC registered in the period 1992-2001, inclusive. RV, RTV and important clinic-pathological variables were studied. All patients had T1 tumours including detrusor muscle at the histopathological examination. Median values for RV and RTV were cutoff points for dichotomisation and 3 cm was the cutoff point for tumour size measured at TUR. Recurrence and progression were analysed using Kaplan-Meier curves with Log-rank test and Cox Proportional Hazards analysis. Results: Out of 211 patients we observed low RV in 112 (53%), low RTV in 113 (54%) and tumour size > 3 cm in 109 (52%). Patients with tumour size > 3 cm and low RV had shorter time to recurrence and progression compared to those with high RV (p = 0.006 and p = 0.087, respectively) and this was also the case when comparing patients with low RTV versus high RTV (p < 0.001 and p = 0.017, respectively). Conclusions: Patients with tumours > 3 cm and low RV or low RTV at TUR for T1 UBC are at higher risk for recurrence or progression, indicating an insufficient TUR. Extensive SLR is particularly important for these patients. RV and RTV might also be used as markers to monitor the quality of the TUR to improve treatment outcome.

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Dose, duration and strain of bacillus Calmette–Guerin in the treatment of nonmuscle invasive bladder cancer

Abstract: Supplemental Digital Content is available in the text

Cited by 32 publications

References 45 publications

Should intravesical Bacillus Calmette–Guerin (BCG) treatment be administered to patients with T0 after repeat transurethral resection of bladder tumor in patients with high-risk non-muscle invasive bladder cancer?

Should intravesical Bacillus Calmette–Guerin (BCG) treatment be administered to patients with T0 after repeat transurethral resection of bladder tumor in patients with high-risk non-muscle invasive bladder cancer?

Impact of maintenance therapy using a half dose of the bacillus Calmette–Guérin Tokyo strain on recurrence of intermediate and high-risk nonmuscle invasive bladder cancer: a retrospective single-center study

The Resected Tumour Volume of the Specimen as a Marker of the Quality of the Transurethral Resection in T1 Urinary Bladder Cancer

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