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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.


Related in: MedlinePlus

Forest plot of disease-free survival across 2 studies for perioperative instillation or not. HR = hazard ratio, CI = confidence interval, CIS = carcinoma in situ.
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Figure 3: Forest plot of disease-free survival across 2 studies for perioperative instillation or not. HR = hazard ratio, CI = confidence interval, CIS = carcinoma in situ.

Mentions: Disease-free survival was the primary outcome measure in this meta-analysis. Using a random-effects model, 5 multivariate HRs and CIs were directly extracted from the studies, and 2 HRs and CIs were calculated using the method mentioned before. The pooled HR was 0.69 (95% CI, 0.48–1.00; P = 0.048, Figure 2). This result represented a significantly better DFS (31% relative decrease in the risk of recurrence) in patients treated with combination therapy, although substantial heterogeneity existed (I2 = 73.3%; P = 0.001, Figure 2). The pooled HR from 2 studies revealed that 1 perioperative instillation significantly improved the efficacy of delayed BCG monotherapy in DFS (HR = 0.6; 95% CI, 0.38–0.92; P = 0.021, Figure 3) without heterogeneity.


Combination of Intravesical Chemotherapy and Bacillus Calmette – Guerin Versus Bacillus Calmette – Guerin Monotherapy in Intermediate- and High-risk Nonmuscle Invasive Bladder Cancer
Forest plot of disease-free survival across 2 studies for perioperative instillation or not. HR = hazard ratio, CI = confidence interval, CIS = carcinoma in situ.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Forest plot of disease-free survival across 2 studies for perioperative instillation or not. HR = hazard ratio, CI = confidence interval, CIS = carcinoma in situ.
Mentions: Disease-free survival was the primary outcome measure in this meta-analysis. Using a random-effects model, 5 multivariate HRs and CIs were directly extracted from the studies, and 2 HRs and CIs were calculated using the method mentioned before. The pooled HR was 0.69 (95% CI, 0.48–1.00; P = 0.048, Figure 2). This result represented a significantly better DFS (31% relative decrease in the risk of recurrence) in patients treated with combination therapy, although substantial heterogeneity existed (I2 = 73.3%; P = 0.001, Figure 2). The pooled HR from 2 studies revealed that 1 perioperative instillation significantly improved the efficacy of delayed BCG monotherapy in DFS (HR = 0.6; 95% CI, 0.38–0.92; P = 0.021, Figure 3) without heterogeneity.

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.


Related in: MedlinePlus