Papillary Recurrence of Bladder Cancer at First Evaluation after Induction Bacillus Calmette-Guérin Therapy: Implication for Clinical Trial Design: Beyond the Abstract
Various clinical factors such as recurrence with lamina propria (clinical stage T1) involvement following induction BCG have been found to be predictive of progression of disease and many experts would strongly recommended radical cystectomy for treatment. Unfortunately, there is a paucity of evidence regarding the outcomes of patients with a Ta papillary recurrence at the 3-month evaluation following BCG treatment. Furthermore, the lack of prognostic information for these subgroup of patients has made their classification in clinical trial design unclear.
In our review of a contemporary cohort treated with BCG, we found that patients with a high-grade papillary (clinical stage Ta) recurrence at the first evaluation following BCG have a risk of progression similar to patients with a cT1 recurrence. However, we also found that patients with a low-grade papillary recurrence at 3-months have a relatively benign subsequent course, and none experienced progression of disease. Our findings support the incorporation of patients with a high-grade cTa recurrence following induction BCG into clinical trials for secondary agents, while patients with a low-grade cTa recurrence can safely be excluded from such trials.
Written by: Ashish M. Kamat and Chinedu O Mmeje
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