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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.


Forest plot of progression-free survival for different methods of instillation. HR = hazard ratio, CI = confidence interval.
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Figure 7: Forest plot of progression-free survival for different methods of instillation. HR = hazard ratio, CI = confidence interval.

Mentions: The subgroup analyses were shown in Figure 7. We analyzed some potential reasons for heterogeneity in PFS, such as tumor risk, chemotherapy agents, etc. One potential explanation for this heterogeneity was the electromotive MMC from Di Stasi et al.16 No significant benefit was detected in patients who received passive instillation (HR = 1.10; 95% CI, 0.74–1.65; P = 0.635, heterogeneity P = 0.41; I2 = 0%).


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 progression-free survival for different methods of instillation. HR = hazard ratio, CI = confidence interval.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 7: Forest plot of progression-free survival for different methods of instillation. HR = hazard ratio, CI = confidence interval.
Mentions: The subgroup analyses were shown in Figure 7. We analyzed some potential reasons for heterogeneity in PFS, such as tumor risk, chemotherapy agents, etc. One potential explanation for this heterogeneity was the electromotive MMC from Di Stasi et al.16 No significant benefit was detected in patients who received passive instillation (HR = 1.10; 95% CI, 0.74–1.65; P = 0.635, heterogeneity P = 0.41; I2 = 0%).

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.