Sequential Chemoimmunotherapy Using Mitomycin Followed by Bacillus Calmette-Guerin (MCC + BCG) Versus Single-Agent Immunotherapy (BCG) for Recurrent Superficial Bladder Tumors

Abstract

INTRODUCTION:The purpose of the present study was to compare the outcomes of patients receiving sequential chemoimmunotherapy using mitomycin (MMC) and bacillus Calmette-Guerin (BCG) with the outcomes of patients receiving BCG alone for the treatment of recurrent superficial bladder tumors. METHODS:A total of 56 patients with recurrent Ta or T1 bladder tumors were enrolled in this prospective randomized study. Group 1 (n = 29 patients) received MMC instillation immediately after resection followed by weekly instillation for 4 weeks. Patients then received BCG monthly for 1 year. Group 2 (n = 27) received only BCG, instilled weekly for 6 weeks and then monthly for 1 year. RESULTS:There was a significant treatment effect for both groups, as indicated by a reduction in mean recurrence rate and recurrence index (P = .001). However, the difference in recurrence rate and recurrence index distributions after treatment was significant in favor of group 1. The mean follow-up period was 24 months (range, 3-30 months).Recurrent tumors were found in 9 patients (31%) in group 1 and 16 patients (70%) in group 2 at the end of the follow-up period. Kaplan-Meier estimates were significantly different throughout the follow-up period. MMC followed by monthly BCG was significantly superior to BCG in the time to initial recurrence (log rank P < .0024). CONCLUSIONS:Patients receiving BCG single-agent immunotherapy and patients receiving sequential chemoimmunotherapy using MMC instillations followed by monthly BCG instillation both had significant treatment effects. However, the difference in recurrence rate and recurrence index distributions after treatment was significant in favor of the group receiving the sequential therapy.UroToday International Journal ® UI J

The role of single instillation chemotherapy in patients who receive subsequent bacillus Calmette-Guérin: A retrospective single centre study, and systematic review of the literature

“…19 KaplanMeier analysis demonstrated the similar curves of the two groups, but multivariate analysis, controlling for the other factors, demonstrated that the combination group had a HR of 0.69 (95% CI 0.45-1.47). Unfortunately, two of these randomized studies 16,17 did not report HR data that were valid for inclusion, and our cumulative analysis limited to randomized prospective studies did not reach statistical significance (Fig. 3a).…”

“…Six articles ultimately met our predefined inclusion criteria, and were included in the final analyses. [14][15][16][17][18][19] Including our retrospective study, this provided a total of 856 cases (7 studies) for systematic review (Table 3).…”

“…17 They found that tumour recurrence was more frequently observed in patients in the BCG alone group (70% vs. 31%). In another prospective randomized trial, Gülpinar and colleagues assigned patients to treatment with perioperative MMC followed by subsequent BCG instillations (once a week for 6 weeks), or treatment with BCG alone.…”

A Serum Metabolomic Signature for the Detection and Grading of Bladder Cancer

“…This transitional cell carcinoma (TCC), or urothelial carcinoma, is the most frequent type [6]. Starting from the urothelium, the cancer can spread into the bladder wall and reach adjacent tissues and organs [7]. Based on the degree of invasion, BC is classified into NMIC (non-muscle-invasive cancer) which is confined to the mucosa and lamina propria of the bladder, and therefore does not invade the muscle (stages Tis, Ta, T1) and MIC (muscle-invasive cancer) which extends into the muscle (stage T2), into the perivescical fat layer (stage T3), adjacent tissues (stage T4), or ultimately metastasize to distant organs (stage M1) [6].…”