Time interval from transurethral resection of bladder tumour to bacille Calmette–Guérin induction does not impact therapeutic response

Abstract

To investigate bacille Calmette-Gu erin (BCG) tolerability and response with respect to the timing of BCG administration after transurethral resection of bladder tumour (TURBT) in patients with non-muscle-invasive bladder cancer (NMIBC). Patients and MethodsA review of patients with NMIBC at our institution managed with at least 'adequate BCG' (defined by the United States Food and Drug Administration as at least five of six induction instillations, with two additional instillations comprising either maintenance or repeat induction) at our institution from 2000 to 2018 was performed. Time from TURBT to first instillation of induction BCG was stratified by quartile and analysed as a continuous variable. Kaplan-Meier and log-rank tests analysed differences in recurrence-free (RFS) and progression-free survival (PFS). Cox proportional hazards regression models identified associations between risk factors and survival outcomes. ResultsA total of 518 patients received adequate BCG at a median (range) of 26 (6-188) days from TURBT. Overall, 45 patients (9%) developed BCG intolerance at a median (range) 12 (7-33) instillations. When time from TURBT to BCG was stratified into quartiles, there was no difference with respect BCG intolerance (P = 0.966), RFS (P = 0.632) or PFS (P = 0.789). On both uni-and multivariate regression analysis for RFS and PFS, time from TURBT to BCG was not a significant predictor when analysed by quartile or as a continuous variable (the hazard ratio for RFS was 1.00, 95% confidence interval [CI] 0.99-1.00, P = 0.449; and for PFS was 0.99, 95% CI 0.98-1.00, P = 0.074). ConclusionThe rates of tolerability and response to adequate BCG are not predicated by the timing of induction BCG instillation after TURBT. Early administration in properly selected patients is safe and delays do not affect therapeutic response.

BCG in Bladder Cancer Immunotherapy

“…A European group found that initiation of BCG within 6 weeks of TURBT was associated with a lower rate of cancer recurrence than when BCG treatment was initiated at a later time point [105,106]. Conversely, in an American study of 518 patients time to initiation of BCG after TURBT was not significantly associated with therapeutic response [107].…”

Optimal interval timing between transurethral resection of bladder tumors and Bacillus Calmette‐Guerin perfusion

“…In a recent study (Can Urol Assoc J, 2021, 15(8):230–239), 6 , 16 researchers collected the interval times of 518 patients, with a median time of 26 days (6–188 days). The patients were divided into 4 groups by quartile, and the results of survival analyses demonstrated that the differences in prognosis were statistically insignificant between these 4 groups.…”

Intravesical mitomycin C (MMC) and MMC + cytosine arabinoside for non‐muscle‐invasive bladder cancer: a randomised clinical trial

“…Therefore, further clinical trials using 20 or 40 mg MMC with a larger study population are necessary to determine the clinical usefulness of intravesical MMC + Ara‐C therapy in patients with NMIBC. In the present study, treatment strategies with intravesical therapy are discussed, especially in patients with intermediate‐risk NMIBC [ 26 , 27 ]. We believe that our present results provide important information for discussion on this issue.…”