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Combination of Intravesical Chemotherapy and Bacillus Calmette – Guerin Versus Bacillus Calmette – Guerin Monotherapy in Intermediate- and High-risk Nonmuscle Invasive Bladder Cancer

View Article: PubMed Central - PubMed

ABSTRACT

Urothelial carcinoma of the bladder has become a major cause of morbidity, mortality, and health-related costs. There is still no standard instillation therapy against bladder cancer. A meta-analysis was conducted to evaluate the efficacy and toxicity of adding chemotherapy to Bacillus Calmette–Guerin (BCG) in intermediate- and high-risk nonmuscle invasive bladder cancer (NMIBC).

All randomized controlled trials (RCTs) that evaluated the efficacy of combination therapy and BCG monotherapy for intermediate- and high-risk NMIBC were comprehensively searched. Relevant databases, including PubMed, Embase, Cochrane Central Register of Controlled trials databases, and American Society of Clinical Oncology (http://www.asco.org/ASCO), the clinical trial registration website (ClinicalTrials.gov), and relevant trials from the references of selected studies were searched from initial state up to June 6, 2015. Random-effects model was used to estimate hazard ratios (HRs) statistics. All statistical analyses were performed by STATA (version 13.0, College Station, TX).

Seven studies, including 1373 patients with intermediate- and high-risk NMIBC, were identified. For disease-free survival, the pooled HRs from all studies was 0.69 (95% confidence interval [CI], 0.48–1.00; P = 0.048). The disease-free survival benefit was more apparent among patients with intermediate-risk NMIBC (P = 0.002) or Ta/T1 with/without carcinoma in situ (P < 0.01). In subgroup analysis, a significant reduction in recurrence was found in studies that explored the influence of a perioperative single dose instillation compared with delayed BCG monotherapy (HR = 0.60; 95% CI, 0.38–0.92; P = 0.021). No significant difference was found for progression-free survival (HR = 0.78; 95% CI, 0.43–1.44; P = 0.435).

Patients with intermediate- and high-risk NMIBC who underwent combination therapy achieved lower rates of recurrence than those who underwent BCG therapy alone. No difference in progression-free survival was found between the 2 different therapy schedules. Better efficacy for a perioperative single dose instillation compared with delayed BCG monotherapy was found in this meta-analysis.

No MeSH data available.


Selecting the flowchart for the inclusion of studies in the meta-analysis.
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Figure 1: Selecting the flowchart for the inclusion of studies in the meta-analysis.

Mentions: After removing 962 duplicates, 2617 potential studies were identified through reviewing abstracts and articles. A total of 42 studies were excluded for the following reasons: a lack of combination therapy; incomplete outcome data; no definition of the grade of risk; no comparison group; retrospective data; or not in English. The final set of eligible studies included 7 studies15–21 published from 1999 to 2014. The selection strategy was shown in Figure 1. The characteristics of the 7 included studies were summarized in Table 1. A total of 1373 patients were included in this meta-analysis. Of these patients, 702 patients were treated with combination therapy, and 671 underwent BCG monotherapy. Two studies17,18 included patients with CIS alone, 5 studies15–19 compared the efficacy between MMC + BCG and BCG monotherapy, and 2 studies20,21 compared the efficacy between epirubicin + BCG and BCG monotherapy. In addition, 2 studies19,20 investigated the efficacy of perioperative chemotherapeutic agent instillation compared with delayed BCG monotherapy, and 5 studies16,18–21 compared the toxicity between combination therapy and BCG monotherapy.


Combination of Intravesical Chemotherapy and Bacillus Calmette – Guerin Versus Bacillus Calmette – Guerin Monotherapy in Intermediate- and High-risk Nonmuscle Invasive Bladder Cancer
Selecting the flowchart for the inclusion of studies in the meta-analysis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998288&req=5

Figure 1: Selecting the flowchart for the inclusion of studies in the meta-analysis.
Mentions: After removing 962 duplicates, 2617 potential studies were identified through reviewing abstracts and articles. A total of 42 studies were excluded for the following reasons: a lack of combination therapy; incomplete outcome data; no definition of the grade of risk; no comparison group; retrospective data; or not in English. The final set of eligible studies included 7 studies15–21 published from 1999 to 2014. The selection strategy was shown in Figure 1. The characteristics of the 7 included studies were summarized in Table 1. A total of 1373 patients were included in this meta-analysis. Of these patients, 702 patients were treated with combination therapy, and 671 underwent BCG monotherapy. Two studies17,18 included patients with CIS alone, 5 studies15–19 compared the efficacy between MMC + BCG and BCG monotherapy, and 2 studies20,21 compared the efficacy between epirubicin + BCG and BCG monotherapy. In addition, 2 studies19,20 investigated the efficacy of perioperative chemotherapeutic agent instillation compared with delayed BCG monotherapy, and 5 studies16,18–21 compared the toxicity between combination therapy and BCG monotherapy.

View Article: PubMed Central - PubMed

ABSTRACT

Urothelial carcinoma of the bladder has become a major cause of morbidity, mortality, and health-related costs. There is still no standard instillation therapy against bladder cancer. A meta-analysis was conducted to evaluate the efficacy and toxicity of adding chemotherapy to Bacillus Calmette–Guerin (BCG) in intermediate- and high-risk nonmuscle invasive bladder cancer (NMIBC).

All randomized controlled trials (RCTs) that evaluated the efficacy of combination therapy and BCG monotherapy for intermediate- and high-risk NMIBC were comprehensively searched. Relevant databases, including PubMed, Embase, Cochrane Central Register of Controlled trials databases, and American Society of Clinical Oncology (http://www.asco.org/ASCO), the clinical trial registration website (ClinicalTrials.gov), and relevant trials from the references of selected studies were searched from initial state up to June 6, 2015. Random-effects model was used to estimate hazard ratios (HRs) statistics. All statistical analyses were performed by STATA (version 13.0, College Station, TX).

Seven studies, including 1373 patients with intermediate- and high-risk NMIBC, were identified. For disease-free survival, the pooled HRs from all studies was 0.69 (95% confidence interval [CI], 0.48–1.00; P = 0.048). The disease-free survival benefit was more apparent among patients with intermediate-risk NMIBC (P = 0.002) or Ta/T1 with/without carcinoma in situ (P < 0.01). In subgroup analysis, a significant reduction in recurrence was found in studies that explored the influence of a perioperative single dose instillation compared with delayed BCG monotherapy (HR = 0.60; 95% CI, 0.38–0.92; P = 0.021). No significant difference was found for progression-free survival (HR = 0.78; 95% CI, 0.43–1.44; P = 0.435).

Patients with intermediate- and high-risk NMIBC who underwent combination therapy achieved lower rates of recurrence than those who underwent BCG therapy alone. No difference in progression-free survival was found between the 2 different therapy schedules. Better efficacy for a perioperative single dose instillation compared with delayed BCG monotherapy was found in this meta-analysis.

No MeSH data available.