Study Finds New Treatment Perspectives for Patients With High-Risk Non-Muscle Invasive Bladder Cancer

Non-muscle invasive bladder cancer (NMIBC) is the most common form of bladder cancer, and patients with NMIBC have a “significant chance” of recurrence or progression to muscle-invasive bladder cancer, especially patients in high-risk groups. Current treatments after tumor resection include chemotherapy or intravesical instillation of Bacille Calmette-Guerin (BCG).

As up to 45% of patients with NMIBC “will not benefit from adjuvant intravesical instillation,” a recent study explored the impact of these widely used treatments on bladder cancer prevention, recurrence, and progression by evaluating the efficacy, feasibility, and safety of introducing intra-arterial chemotherapy (IAC) to existing intravesical treatment.

A team of researchers from China conducted the study by collecting data from 170 patients with high-risk NMIBC who received transurethral resection of bladder tumor (TURBT) in the last five years. Twenty-seven patients were excluded due to exclusion criteria and the remaining 143 participants were divided into three cohorts.

The first cohort received BCG alone, the second cohort received BCG plus IAC, the third cohort received intravesical chemotherapy (IVC) plus IAC, and all groups received “standard intravesical instillation of BCG or chemotherapeutic agents.” Both groups receiving IAC as part of their treatment were given four courses of IAC.

According to the study findings, the median follow-up time was 47 months, “ranging from 20 to 60 months.” The restricted mean survival time (RMST), representing the recurrence and progression rates of the BCG plus IAC cohort, “differed significantly when compared with the BCG group (P=.029 and .004, respectively) and the IVC plus IAC group (P=.004 and .006, respectively).”

The study authors used Kaplan-Meier plots to determine that the recurrence and progression-free survival (PFS) of the BCG plus IAC group were “significantly higher” than that of the BCG (P=.028) and IVC plus IAC (P=.033) cohorts.

Regarding RMST, the BCG and IVC plus IAC groups showed similar results (P=.156 and P=.935, respectively). Recurrence was measured at P=.627 and PFS was measured at P=.931. Twenty percent of patients experienced the adverse effects of IAC and 65% experienced adverse reactions to intravesical instillation. Most adverse effects were scored as grades 1 or 2.

“Analysis showed that tumor recurrence and progression rate in the BCG plus IAC group was lower than the BCG and IVC plus IAC groups while patients in the IVC plus IAC group suffered from milder adverse effects in cystitis and flu-like symptoms,” the investigators wrote. “Our findings may provide a new perspective for urologists when treating patients with high-risk NMIBC.”

Reference: Urologic Oncology: Seminars and Original Investigations