Maintenance therapy with bacillus Calmette-Guérin Connaught strain clearly prolongs recurrence-free survival following transurethral resection of bladder tumour for non-muscle-invasive bladder cancer
Article first published online: 22 DEC 2010
© 2010 THE AUTHORS. BJU INTERNATIONAL © 2010 BJU INTERNATIONAL
Volume 108, Issue 2, pages 187–195, July 2011
How to Cite
Hinotsu, S., Akaza, H., Naito, S., Ozono, S., Sumiyoshi, Y., Noguchi, S., Yamaguchi, A., Nagamori, S., Terai, A., Nasu, Y., Kume, H., Tomita, Y., Tanaka, Y., Samma, S., Uemura, H., Koga, H. and Tsushima, T. (2011), Maintenance therapy with bacillus Calmette-Guérin Connaught strain clearly prolongs recurrence-free survival following transurethral resection of bladder tumour for non-muscle-invasive bladder cancer. BJU International, 108: 187–195. doi: 10.1111/j.1464-410X.2010.09891.x
- Issue published online: 1 JUL 2011
- Article first published online: 22 DEC 2010
- Accepted for publication 21 July 2010
- bacillus Calmette-Guérin;
- maintenance therapy;
- non-muscle-invasive bladder cancer;
- intravesical therapy;
- transurethral resection;
- prevention of recurrence
Study Type – Therapy (RCT)
Level of Evidence 1b
- • To confirm the recurrence-preventing efficacy and safety of 18-month bacillus Calmette-Guérin (BCG) maintenance therapy for non-muscle-invasive bladder cancer.
PATIENTS AND METHODS
- • The enrolled patients had been diagnosed with recurrent or multiple non-muscle-invasive bladder cancer (stage Ta or T1) after complete transurethral resection of bladder tumours (TURBT).
- • The patients were randomized into three treatment groups: a maintenance group (BCG, 81 mg, intravesically instilled once weekly for 6 weeks as induction therapy, followed by three once-weekly instillations at 3, 6, 12 and 18 months after initiation of the induction therapy), a non-maintenance group (BCG, 81 mg, intravesically instilled once weekly for 6 weeks) and an epirubicin group (epirubicin, 40 mg, intravesically instilled nine times). The primary endpoint was recurrence-free survival (RFS).
- • Efficacy analysis was performed for 115 of the full-analysis-set population of 116 eligible patients, including 41 maintenance group patients, 42 non-maintenance group patients and 32 epirubicin group patients.
- • At the 2-year median point of the overall actual follow-up period, the final cumulative RFS rates in the maintenance, non-maintenance and epirubicin groups were 84.6%, 65.4% and 27.7%, respectively.
- • The RFS following TURBT was significantly prolonged in the maintenance group compared with the non-maintenance group (generalized Wilcoxon test, P= 0.0190).
- • BCG maintenance therapy significantly prolonged the post-TURBT RFS compared with BCG induction therapy alone or epirubicin intravesical therapy.