Bacillus Calmette-Guérin (BCG) treatment without maintenance in patients with high-risk non-muscle-invasive bladder cancer (NMIBC) compares favorably with trials in which comparable patients received maintenance BCG.
In a study published in European Urology (online ahead of print), researchers also found that relapsing patients can be salvaged with retreatment and can avoid significant BCG toxicities while achieving comparable outcomes.
Harry Herr, MD, of Memorial Sloan-Kettering Cancer Center in New York, and his colleagues studied 1,021 consecutive patients with bladder cancer from 1995 to 2006. All patients underwent restaging transurethral resection (TUR) and were found to have high-risk NMIBC. The patients received six weekly instillations of Connaught strain (81 mg) BCG therapy and evaluated for response at three and six months. No patients received maintenance BCG therapy. Of the 1,021 patients, 816 (79%) had a complete response to induction BCG therapy. During the minimum follow-up period of five years, 32% of the 816 patients were retreated with another six-week course of BCG for tumor relapse.
Disease recurred in 27% of patients within two years and half the patients by five years. Disease progression occurred in 11% and 4% died of urothelial cancer without receiving maintenance BCG therapy.
Compared with published raw data that included similar high-risk patients, maintenance BCG did not appear to offer significant advantages over induction BCG alone followed by retreatment for relapse. The authors wrote, “Admitting that maintenance BCG may prevent a few more recurrences than induction BCG alone, relapsing patients can be salvaged with retreatment rather than exposing all patients to the toxicity associated with maintenance.”