The aims of this study were to review tolerance to BCG maintenance in a UK based population of patients with high risk superficial bladder cancer (HRSBC). We have employed two different BCG maintenance regimens and compared our outcomes with those described by SWOG 8507.
Patients and methods:
Data from 81 patients confirmed to have HRSBC were retrospectively analysed for tolerability and cancer outcomes for either single or triplet dose BCG maintenance.
Results:
77 patients tolerated induction BCG and underwent BCG maintenance, 24 in the single and 53 in the triplet groups. Mean follow-up was 38 months. The maintenance tolerance was 89% for single and 50% for triplet instillations.
Conclusions:
In a single centre UK group of patients, tolerance to maintenance BCG was higher than previously reported by SWOG 8507 and a single dose maintenance regimen was better tolerated than the triplet dose. This review of a non-randomised series of two BCG maintenance regimens is too small to alter current guidelines, but does suggest the need for a much larger multi-centre UK study comparing triplet maintenance with less intense regimens.
EpsteinJIAminMBReuterVRMostofiFK. The World Health Organization/International Society of Urological Pathology consensus classification of urothelial (transitional cell) neoplasms of the urinary bladder. Bladder Consensus Conference Committee. Am J Surg Pathol1998; 22 (December): 1435–48.
2.
Millan-RodriguezFChechile-TonioloGSalvador-BayarriJPalouJAlgabaFVicente-RodriguezJ. Primary superficial bladder cancer risk groups according to progression, mortality and recurrence. J Urol2000; 164 (September): 680–4.
3.
OosterlinckW AvdM SylvesterRBöhleARintalaENarvónE SolsonaLobelB. Guidelines on TaT 1 (non-muscle invasive). Bladder Cancer2006: 1–17.
4.
LammDLBlumensteinBACrawfordEDMontieJEScardinoPGrossmanHBA randomized trial of intravesical doxorubicin and immunotherapy with bacille Calmette-Guerin for transitional-cell carcinoma of the bladder. N Engl J Med1991; 325 (October): 1205–9.
5.
SchwalbDMAddonizioJCCamilleriJChoudhuryMSEshghiM. Maintenance intravesical bacillus calmette-guerin for superficial transitional cell carcinoma of bladder. A retrospective study. Urology1990; 36 (September): 222–5.
6.
MoralesAEidingerDBruceAW. Intracavitary Bacillus Calmette-Guerin in the treatment of superficial bladder tumors. J Urol1976; 116 (August): 180–3.
7.
SylvesterRJvan derMALammDL. 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 Urol2002; 168 (November): 1964–70.
8.
LammDLBlumensteinBACrissmanJDMontieJEGottesmanJELoweBAMaintenance bacillus Calmette-Guerin immunotherapy for recurrent TA T1 and carcinoma in situ transitional cell carcinoma of the bladder: a randomized Southwest Oncology Group Study. J Urol2000; 163: 1124–9.
9.
van der MeijdenAPSylvesterRJOosterlinckWHoeltlWBonoAV. Maintenance Bacillus Calmette-Guerin for Ta T1 bladder tumors is not associated with increased toxicity: results from a European Organisation for Research and Treatment of Cancer Genito-Urinary Group Phase III Trial. Eur Urol2003; 44 (October): 429–34.
10.
BohleABalckFvon WeitersheimJJochamD. The quality of life during intravesical bacillus Calmette-Guerin therapy. J Urol1996; 155 (April): 1221–6.
11.
GoffinJRRajanRSouhamiL. Tolerance of radiotherapy and chemotherapy in elderly patients with bladder cancer. Am J Clin Oncol2004; 27 (April): 172–7.
12.
LammDL. Efficacy and safety of bacille Calmette-Guerin immunotherapy in superficial bladder cancer. Clin Infect Dis2000; 31 (September (Suppl 3)): S86–90.
13.
MoralesANickelJCWilsonJW. Dose-response of bacillus Calmette-Guerin in the treatment of superficial bladder cancer. J Urol1992; 147 (May): 1256–8.
14.
PaganoFBassiPMilaniCMeneghiniAMaruzziDGarbeglioA. A low dose bacillus Calmette-Guerin regimen in superficial bladder cancer therapy: is it effective?J Urol1991; 146 (July): 32–5.
15.
LufteneggerWAckermannDKFutterliebAKraftRMinderCENadelhaftPStuderUE. Intravesical versus intravesical plus intradermal bacillus Calmette-Guerin: a prospective randomized study in patients with recurrent superficial bladder tumors. J Urol1996; 155 (February): 483–7.
16.
SaintFPatardJJIraniJSalomonLHoznekALegrandPLeukocyturia as a predictor of tolerance and efficacy of intravesical BCG maintenance therapy for superficial bladder cancer. Urology2001; 57 (April): 617–21, discussion 21–22.
17.
SylvesterRJvan der MeijdenAPOosterlinckWHoeltlWBonoAV. The side effects of Bacillus Calmette-Guerin in the treatment of Ta T1 bladder cancer do not predict its efficacy: results from a European Organisation for Research and Treatment of Cancer Genito-Urinary Group Phase III Trial. Eur Urol2003; 44 (October): 423–8.
18.
LammDLDeHavenJIShriverJSarosdyMF. Prospective randomized comparison of intravesical with percutaneous bacillus Calmette-Guerin versus intravesical bacillus Calmette-Guerin in superficial bladder cancer. J Urol1991; 145 (April): 738–40.
19.
BadalamentRAHerrHWWongGYGneccoCPinskyCMWhitmoreWFJrA prospective randomized trial of maintenance versus nonmaintenance intravesical bacillus Calmette-Guerin therapy of superficial bladder cancer. J Clin Oncol1987; 5 (March): 441–9.
20.
HudsonMARatliffTLGillenDPHaaffEODresnerSMCatalonaWJ. Single course versus maintenance bacillus Calmette-Guerin therapy for superficial bladder tumors: a prospective, randomized trial. J Urol1987; 138 (August): 295–8.
AllardPBernardPFradetYTetuB. The early clinical course of primary Ta and T1 bladder cancer: a proposed prognostic index. Br J Urol1998; 81 (May): 692–8.
23.
KurthKHDenisLBouffiouxCSylvesterRDebruyneFMPavone-MacalusoMOosterlinckW. Factors affecting recurrence and progression in superficial bladder tumours. Eur J Cancer1995; 31A (October): 1840–6.
24.
LambertEHPierorazioPMOlssonCABensonMCMcKiernanJMPoonS. The increasing use of intravesical therapies for stage T1 bladder cancer coincides with decreasing survival after cystectomy. BJU Int2007; 100 (July): 33–6.
25.
WoltersUWolfTStutzerHSchroderT. ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth1996; 77 (August): 217–22.
