alexa Bacillus Calmette-Guérin without maintenance therapy for high-risk non-muscle-invasive bladder cancer.


Journal of Transplantation Technologies & Research

Author(s): Herr HW, Dalbagni G, Donat SM

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Abstract BACKGROUND: Bacillus Calmette-Guérin (BCG) is the standard intravesical treatment of high-risk noninvasive (Ta, T1, Tis) bladder cancer. Maintenance BCG is recommended for maximum efficacy. OBJECTIVE: We compared our results in a large cohort of high-risk bladder cancer patients who received BCG without maintenance with published results from randomized maintenance BCG trials. DESIGN, SETTING, AND PARTICIPANTS: A cohort of 1021 patients underwent restaging transurethral resection for high-risk (Ta, T1, Tis) bladder cancer. INTERVENTION: Patients received a 6-wk induction course of BCG therapy. Responding patients did not receive maintenance BCG. Relapsing patients were eligible for retreatment with BCG. All patients were followed for a minimum of 5 yr. MEASUREMENTS: End points were 5-yr tumor- and progression-free survival rates. RESULTS AND LIMITATIONS: Of 816 complete responders to induction BCG, 2- and 5-yr recurrence-free survival rates were 73\% and 46\%, respectively. The progression-free survival rate was 89\%. Progression-free survival time was 56 mo (95\% confidence interval, 55-58 mo). Thirty-two percent of the patients required another course of BCG therapy. We cannot exclude that maintenance BCG may benefit patients beyond 5 yr over induction BCG alone and selective BCG retreatments. CONCLUSIONS: Our results with BCG treatment without maintenance of patients with high-risk non-muscle-invasive bladder cancer compare favorably with trials in which comparable patients received maintenance BCG. Copyright © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved. This article was published in Eur Urol and referenced in Journal of Transplantation Technologies & Research

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