Tolerability and Efficacy of BCG After NMIBC Recurrence Following Bladder-Preserving Therapy

Results from a retrospective study that explored the tolerability and efficacy of bacillus Calmette-Guérin (BCG) therapy after chemoradiotherapy in patients with muscle-invasive bladder cancer (MIBC) were presented at the American Urological Association 2023 Annual Meeting.

A multidisciplinary protocol of bladder-preserving therapy for highly selected patients with MIBC often includes radiotherapy and concomitant chemotherapy. Some of these patients experience recurrence of intravesical non-muscle-invasive bladder cancer (NMIBC).

A group of 19 patients with clinical stage T2-T4aN0M0 urothelial carcinoma of the bladder were included in the study. The patients were administered BCG between 2012 and 2019 after receiving bladder-preserving therapy. The bladder-preserving strategies consisted of separate treatments for different patients.

Patients with stage cT2 cancer underwent maximal transurethral resection (TURBT), and patients with cT3-T4a disease underwent biopsy. All patients received neoadjuvant chemotherapy with a gemcitabine/cisplatin regimen, and patients then completed maximal TURBT. Those with pT0 disease or who were downstaged to pT1/pTa disease were given concurrent chemoradiotherapy. Patients with intravesical NMIBC recurrence were recommended with TURBT followed by BCG administration.

The BCG instillation schedules included induction therapy, which consisted of BCG 120 mg weekly for 6 cycles and then a 3-month gap, followed by maintenance therapy, which consisted of BCG 120 mg weekly for 3 cycles. The maintenance therapy was then repeated every 6 months for 1 to 3 years.

All 19 patients completed BCG induction therapy, and 11 patients (57.9%) started maintenance therapy. The median follow-up since recurrence was 36.2 months. The 1-year and 3-year probabilities of disease-free survival and overall survival were 71.1%/65.2% and 88.8%/81.4%, respectively.

The most common BCG-related adverse events were bladder irritation (89.5% of patients), followed by hematuria (15.8% of patients), and fever, arthritis, and bladder tuberculosis (5.3% of patients each). No patients experienced bladder contracture after BCG instillation.

BCG instillation after chemoradiotherapy for NMIBC offers tolerability and efficacy in an acceptable and controllable treatment. The study results indicate an alternative strategy to radical cystectomy for comprehensive bladder-preserving therapy for MIBC.