Diminished Short-Term Efficacy of Reduced-Dose Induction BCG in the Treatment of Non-Muscle Invasive Bladder Cancer
The ongoing Bacillus Calmette-Guérin (BCG) shortage has created challenges for the treatment of non-muscle invasive bladder cancer (NMIBCa). Our objective was to evaluate the efficacy of reduced-dose induction BCG (RD-iBCG) compared to full-dose induction BCG (FD-iBCG) regarding recurrence rates. We...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-07-01
|
| Series: | Cancers |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2072-6694/15/14/3746 |
| _version_ | 1797589913645875200 |
|---|---|
| author | David A. Ostrowski Raju R. Chelluri Matthew Herzig Leilei Xia Brian D. Cortese Daniel S. Roberson Thomas J. Guzzo Daniel J. Lee S. Bruce Malkowicz |
| author_facet | David A. Ostrowski Raju R. Chelluri Matthew Herzig Leilei Xia Brian D. Cortese Daniel S. Roberson Thomas J. Guzzo Daniel J. Lee S. Bruce Malkowicz |
| author_sort | David A. Ostrowski |
| collection | DOAJ |
| description | The ongoing Bacillus Calmette-Guérin (BCG) shortage has created challenges for the treatment of non-muscle invasive bladder cancer (NMIBCa). Our objective was to evaluate the efficacy of reduced-dose induction BCG (RD-iBCG) compared to full-dose induction BCG (FD-iBCG) regarding recurrence rates. We hypothesized that patients receiving RD-iBCG may recur at a higher rate compared to those who received FD-iBCG therapy. A retrospective review of all patients with NMIBCa treated with intravesical therapy at our institution between 2015–2020 was conducted. Inclusion criteria consisted of having a diagnosis of AUA intermediate or high-risk NMIBCa with an indication for a six-week induction course of FD or RD-BCG with at least 1 year of documented follow up. The data were censored at one year. Propensity score matching for age, sex, tumor pathology, and initial vs. recurrent disease was performed. The primary endpoint was bladder cancer recurrence, reported as recurrence-free survival. A total of 254 patients were reviewed for this study. Our final cohort was 139 patients after exclusion. Thirty-nine percent of patients had HGT1 disease. 38.6% of patients receiving RD-BCG developed a recurrence of bladder cancer within a one-year follow-up as compared to 33.7% of patients receiving FD therapy. After propensity matching, this value remained statistically significant (<i>p</i> = 0.03). In conclusion, RD-iBCG for NMIBCa is associated with a significantly greater risk of recurrence than full-dose induction therapy, suggesting that RD-iBCG may not be equivalent or non-inferior to full-dose administration in the short term. |
| first_indexed | 2024-03-11T01:12:52Z |
| format | Article |
| id | doaj.art-a5ce0487cae6439eae111233a6b2fc23 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-11T01:12:52Z |
| publishDate | 2023-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-a5ce0487cae6439eae111233a6b2fc232023-11-18T18:43:34ZengMDPI AGCancers2072-66942023-07-011514374610.3390/cancers15143746Diminished Short-Term Efficacy of Reduced-Dose Induction BCG in the Treatment of Non-Muscle Invasive Bladder CancerDavid A. Ostrowski0Raju R. Chelluri1Matthew Herzig2Leilei Xia3Brian D. Cortese4Daniel S. Roberson5Thomas J. Guzzo6Daniel J. Lee7S. Bruce Malkowicz8Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA 19104, USADivision of Urology and Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USADepartment of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02115, USADivision of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA 19104, USADivision of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA 19104, USADivision of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA 19104, USADivision of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA 19104, USADivision of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA 19104, USADivision of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA 19104, USAThe ongoing Bacillus Calmette-Guérin (BCG) shortage has created challenges for the treatment of non-muscle invasive bladder cancer (NMIBCa). Our objective was to evaluate the efficacy of reduced-dose induction BCG (RD-iBCG) compared to full-dose induction BCG (FD-iBCG) regarding recurrence rates. We hypothesized that patients receiving RD-iBCG may recur at a higher rate compared to those who received FD-iBCG therapy. A retrospective review of all patients with NMIBCa treated with intravesical therapy at our institution between 2015–2020 was conducted. Inclusion criteria consisted of having a diagnosis of AUA intermediate or high-risk NMIBCa with an indication for a six-week induction course of FD or RD-BCG with at least 1 year of documented follow up. The data were censored at one year. Propensity score matching for age, sex, tumor pathology, and initial vs. recurrent disease was performed. The primary endpoint was bladder cancer recurrence, reported as recurrence-free survival. A total of 254 patients were reviewed for this study. Our final cohort was 139 patients after exclusion. Thirty-nine percent of patients had HGT1 disease. 38.6% of patients receiving RD-BCG developed a recurrence of bladder cancer within a one-year follow-up as compared to 33.7% of patients receiving FD therapy. After propensity matching, this value remained statistically significant (<i>p</i> = 0.03). In conclusion, RD-iBCG for NMIBCa is associated with a significantly greater risk of recurrence than full-dose induction therapy, suggesting that RD-iBCG may not be equivalent or non-inferior to full-dose administration in the short term.https://www.mdpi.com/2072-6694/15/14/3746BCG shortagereduced dosebacillus Calmette-Guérinnon-muscle invasive bladder cancer |
| spellingShingle | David A. Ostrowski Raju R. Chelluri Matthew Herzig Leilei Xia Brian D. Cortese Daniel S. Roberson Thomas J. Guzzo Daniel J. Lee S. Bruce Malkowicz Diminished Short-Term Efficacy of Reduced-Dose Induction BCG in the Treatment of Non-Muscle Invasive Bladder Cancer Cancers BCG shortage reduced dose bacillus Calmette-Guérin non-muscle invasive bladder cancer |
| title | Diminished Short-Term Efficacy of Reduced-Dose Induction BCG in the Treatment of Non-Muscle Invasive Bladder Cancer |
| title_full | Diminished Short-Term Efficacy of Reduced-Dose Induction BCG in the Treatment of Non-Muscle Invasive Bladder Cancer |
| title_fullStr | Diminished Short-Term Efficacy of Reduced-Dose Induction BCG in the Treatment of Non-Muscle Invasive Bladder Cancer |
| title_full_unstemmed | Diminished Short-Term Efficacy of Reduced-Dose Induction BCG in the Treatment of Non-Muscle Invasive Bladder Cancer |
| title_short | Diminished Short-Term Efficacy of Reduced-Dose Induction BCG in the Treatment of Non-Muscle Invasive Bladder Cancer |
| title_sort | diminished short term efficacy of reduced dose induction bcg in the treatment of non muscle invasive bladder cancer |
| topic | BCG shortage reduced dose bacillus Calmette-Guérin non-muscle invasive bladder cancer |
| url | https://www.mdpi.com/2072-6694/15/14/3746 |
| work_keys_str_mv | AT davidaostrowski diminishedshorttermefficacyofreduceddoseinductionbcginthetreatmentofnonmuscleinvasivebladdercancer AT rajurchelluri diminishedshorttermefficacyofreduceddoseinductionbcginthetreatmentofnonmuscleinvasivebladdercancer AT matthewherzig diminishedshorttermefficacyofreduceddoseinductionbcginthetreatmentofnonmuscleinvasivebladdercancer AT leileixia diminishedshorttermefficacyofreduceddoseinductionbcginthetreatmentofnonmuscleinvasivebladdercancer AT briandcortese diminishedshorttermefficacyofreduceddoseinductionbcginthetreatmentofnonmuscleinvasivebladdercancer AT danielsroberson diminishedshorttermefficacyofreduceddoseinductionbcginthetreatmentofnonmuscleinvasivebladdercancer AT thomasjguzzo diminishedshorttermefficacyofreduceddoseinductionbcginthetreatmentofnonmuscleinvasivebladdercancer AT danieljlee diminishedshorttermefficacyofreduceddoseinductionbcginthetreatmentofnonmuscleinvasivebladdercancer AT sbrucemalkowicz diminishedshorttermefficacyofreduceddoseinductionbcginthetreatmentofnonmuscleinvasivebladdercancer |