The role of single instillation chemotherapy in patients who receive subsequent bacillus Calmette-Guérin: A retrospective single centre study, and systematic review of the literature

Kazuhiro Matsumoto, Tatsuo Gondo, Nozomi Hayakawa, Takahiro Maeda, Akiharu Ninomiya, So Nakamura

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Abstract

Introduction: This retrospective study was undertaken to evaluate the combined effect of immediate intravesical chemotherapy and subsequent bacillus Calmette-Guérin (BCG) therapy. Methods: The study population consisted of 207 intermediate- or high-risk patients with non-muscle invasive bladder cancer who underwent an induction course of BCG between 1993 and 2007. We introduced single immediate instillation of 50 mg epirubicin for all cases in 2004, and thus earlier cases could be considered as historical controls. The primary endpoint was recurrence-free survival (RFS). For cumulative analysis, we systematically reviewed studies indexed in databases. Including ours, the records of 856 patients from a total of 7 studies, including ours, were finally analyzed. Results: In our cohort, the 5-year RFS in patients who received the combination therapy was 66.2%, compared to 55.2% in the BCG alone group (p = 0.149). Multivariate analysis on tumour recurrence showed that patients with the combination therapy had a hazard ratio (HR) of 0.74 (p = 0.189). A subsequent literature review revealed that RFS rates in the combination groups were higher than those in the corresponding BCG alone groups in 4/7 studies (p = 0.02-0.15), and lower in 1 study (p = 0.51). We identified 5 studies which examined a HR for combination therapy, and performed a cumulative analysis. Adding a single chemo-instillation prior to BCG resulted in a significant reduction in tumour recurrence (summary HR 0.69, p = 0.010). Conclusions: Our analysis suggested that the combination of single chemo-instillation with subsequent BCG therapy exhibited an additive effect against potential tumour recurrence.

Original languageEnglish
Pages (from-to)E411-E416
JournalCanadian Urological Association Journal
Volume9
Issue number7-8
DOIs
Publication statusPublished - 2015 Jul 1
Externally publishedYes

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Bacillus
Recurrence
Drug Therapy
Therapeutics
Neoplasms
Epirubicin
Survival
Urinary Bladder Neoplasms
Multivariate Analysis
Survival Rate
Retrospective Studies
Databases
Population

ASJC Scopus subject areas

  • Urology

Cite this

The role of single instillation chemotherapy in patients who receive subsequent bacillus Calmette-Guérin : A retrospective single centre study, and systematic review of the literature. / Matsumoto, Kazuhiro; Gondo, Tatsuo; Hayakawa, Nozomi; Maeda, Takahiro; Ninomiya, Akiharu; Nakamura, So.

In: Canadian Urological Association Journal, Vol. 9, No. 7-8, 01.07.2015, p. E411-E416.

Research output: Contribution to journalArticle

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abstract = "Introduction: This retrospective study was undertaken to evaluate the combined effect of immediate intravesical chemotherapy and subsequent bacillus Calmette-Gu{\'e}rin (BCG) therapy. Methods: The study population consisted of 207 intermediate- or high-risk patients with non-muscle invasive bladder cancer who underwent an induction course of BCG between 1993 and 2007. We introduced single immediate instillation of 50 mg epirubicin for all cases in 2004, and thus earlier cases could be considered as historical controls. The primary endpoint was recurrence-free survival (RFS). For cumulative analysis, we systematically reviewed studies indexed in databases. Including ours, the records of 856 patients from a total of 7 studies, including ours, were finally analyzed. Results: In our cohort, the 5-year RFS in patients who received the combination therapy was 66.2{\%}, compared to 55.2{\%} in the BCG alone group (p = 0.149). Multivariate analysis on tumour recurrence showed that patients with the combination therapy had a hazard ratio (HR) of 0.74 (p = 0.189). A subsequent literature review revealed that RFS rates in the combination groups were higher than those in the corresponding BCG alone groups in 4/7 studies (p = 0.02-0.15), and lower in 1 study (p = 0.51). We identified 5 studies which examined a HR for combination therapy, and performed a cumulative analysis. Adding a single chemo-instillation prior to BCG resulted in a significant reduction in tumour recurrence (summary HR 0.69, p = 0.010). Conclusions: Our analysis suggested that the combination of single chemo-instillation with subsequent BCG therapy exhibited an additive effect against potential tumour recurrence.",
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