Intravesical Chemotherapy for Intermediate Risk Non-muscle Invasive Bladder Cancer Recurring After a First Cycle of Intravesical Adjuvant Therapy

Overview

Journal Urol Ann

Specialty Urology

Date 2015 Feb 7

PMID 25657538

Authors

Vincenzo Serretta

Francesco Sommatino

Cristina Scalici Gesolfo

Vito Franco

Giuseppe Cicero

Rosalinda Allegro

Affiliations

Soon will be listed here.

Abstract

Context: The therapeutic strategy in intermediate risk (IR) non-muscle invasive bladder cancer (NMIBC) recurring after intravesical therapy (IT) is not well defined. Most patients are usually retreated by Bacillus Calmette-Guerin (BCG).

Aims: To evaluate the efficacy of intravesical chemotherapy (ICH) given at recurrence after the first cycle of ICH in IR-NMIBC recurring 6 months or later.

Settings And Design: Retrospective analysis of the efficacy of ICH given after previous IT.

Materials And Methods: The clinical files of IR-NMIBC patients recurring later than 6 months after transurethral resection (TUR) and IT and retreated by IT were reviewed. The patients should be at intermediate risk both initially and at the first recurrence. BCG should have been given at full dose. Cytology and cystoscopy were performed 3 monthly for 2 years and then 6 monthly.

Statistical Analysis: The RFS was estimated by the Kaplan-Meier method and the differences between treatment groups were compared by log-rank test. Mann Whitney U-test was used to compare the parameters' distribution for median time to recurrence. Multivariate Cox proportional hazards models were used.

Results: The study included 179 patients. The first IT was ICH in 146 (81.6%) and BCG in 33 (18.4%), re-IT was ICH in 112 (62.6%) and BCG in 67 (37.4%) patients. Median time to recurrence was 18 and 16 months after first and second IT (P = 0.32). At 3 years, 24 (35.8%) and 49 (43.8%) patients recurred after BCG and ICH, respectively (P = 0.90). No difference in RFS was found between BCG and ICH given after a first cycle of ICH (P = 0.23).

Conclusions: Re-treatment with ICH could represent a legitimate option to BCG in patients harboring IR-NMIBC recurring after TUR and previous ICH. Prospective trials are needed.

References

Friedrich M, Pichlmeier U, Schwaibold H, Conrad S, Huland H . Long-term intravesical adjuvant chemotherapy further reduces recurrence rate compared with short-term intravesical chemotherapy and short-term therapy with Bacillus Calmette-Guérin (BCG) in patients with non-muscle-invasive bladder carcinoma. Eur Urol. 2007; 52(4):1123-29. DOI: 10.1016/j.eururo.2007.02.063. View

Sylvester R, Oosterlinck W, Witjes J . The schedule and duration of intravesical chemotherapy in patients with non-muscle-invasive bladder cancer: a systematic review of the published results of randomized clinical trials. Eur Urol. 2008; 53(4):709-19. PMC: 2587437. DOI: 10.1016/j.eururo.2008.01.015. View

Yates D, Brausi M, Catto J, Dalbagni G, Roupret M, Shariat S . Treatment options available for bacillus Calmette-Guérin failure in non-muscle-invasive bladder cancer. Eur Urol. 2012; 62(6):1088-96. DOI: 10.1016/j.eururo.2012.08.055. View

Brausi M, Witjes J, Lamm D, Persad R, Palou J, Colombel M . A review of current guidelines and best practice recommendations for the management of nonmuscle invasive bladder cancer by the International Bladder Cancer Group. J Urol. 2011; 186(6):2158-67. DOI: 10.1016/j.juro.2011.07.076. View

Babjuk M, Burger M, Zigeuner R, Shariat S, van Rhijn B, Comperat E . EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2013. Eur Urol. 2013; 64(4):639-53. DOI: 10.1016/j.eururo.2013.06.003. View

Sylvester R, van der Meijden A, Oosterlinck W, Witjes J, Bouffioux C, Denis L . Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol. 2006; 49(3):466-5. DOI: 10.1016/j.eururo.2005.12.031. View

Sylvester R . Intravesical chemotherapy in non-muscle-invasive bladder cancer: what schedule and duration of treatment?. Eur Urol. 2007; 52(4):951-3. DOI: 10.1016/j.eururo.2007.03.028. View

Herr H, Dalbagni G, Donat S . Bacillus Calmette-Guérin without maintenance therapy for high-risk non-muscle-invasive bladder cancer. Eur Urol. 2011; 60(1):32-6. DOI: 10.1016/j.eururo.2011.03.051. View

Sylvester R, Brausi M, Kirkels W, Hoeltl W, da Silva F, Powell P . Long-term efficacy results of EORTC genito-urinary group randomized phase 3 study 30911 comparing intravesical instillations of epirubicin, bacillus Calmette-Guérin, and bacillus Calmette-Guérin plus isoniazid in patients with intermediate- and.... Eur Urol. 2009; 57(5):766-73. PMC: 2889174. DOI: 10.1016/j.eururo.2009.12.024. View

10.

Serretta V, Morgia G, Altieri V, Di Lallo A, Ruggiero G, Salzano L . A 1-year maintenance after early adjuvant intravesical chemotherapy has a limited efficacy in preventing recurrence of intermediate risk non-muscle-invasive bladder cancer. BJU Int. 2010; 106(2):212-7. DOI: 10.1111/j.1464-410X.2009.09153.x. View

11.

Dalbagni G . Is intravesical bacillus Calmette-Guérin better than mitomycin for intermediate-risk bladder cancer?. Eur Urol. 2009; 56(2):257-8. DOI: 10.1016/j.eururo.2009.04.041. View

12.

Oddens J, Brausi M, Sylvester R, Bono A, van de Beek C, van Andel G . Final results of an EORTC-GU cancers group randomized study of maintenance bacillus Calmette-Guérin in intermediate- and high-risk Ta, T1 papillary carcinoma of the urinary bladder: one-third dose versus full dose and 1 year versus 3 years of.... Eur Urol. 2012; 63(3):462-72. DOI: 10.1016/j.eururo.2012.10.039. View

13.

Sylvester R, van der Meijden A, Lamm D . Intravesical bacillus Calmette-Guerin reduces the risk of progression in patients with superficial bladder cancer: a meta-analysis of the published results of randomized clinical trials. J Urol. 2002; 168(5):1964-70. DOI: 10.1016/S0022-5347(05)64273-5. View

14.

Witjes J, Palou J, Soloway M, Lamm D, Kamat A, Brausi M . Current clinical practice gaps in the treatment of intermediate- and high-risk non-muscle-invasive bladder cancer (NMIBC) with emphasis on the use of bacillus Calmette-Guérin (BCG): results of an international individual patient data survey (IPDS). BJU Int. 2013; 112(6):742-50. PMC: 3933735. DOI: 10.1111/bju.12012. View