(UroToday.com) The 2024 American Urological Association (AUA) annual meeting featured a session on non-invasive bladder cancer, and a presentation by Dr. Mario de Angelis discussing cancer control rates in adequate versus inadequate treatment with adjuvant immunotherapy instillations with BCG. Current guidelines recommend adjuvant BCG immunotherapy for the treatment of intermediate risk and high-risk non-muscle invasive bladder cancer. However, optimal response to BCG is associated with adequate treatment according to international guidelines. At the 2024 AUA annual meeting, Dr. de Angelis and colleagues investigated the impact of inadequate treatment on the risk of recurrence and progression.
This study identified 309 patients treated with TURBT and diagnosed with intermediate risk and high-risk non-muscle invasive bladder cancer in a tertiary referral center between 2012 and 2020. Patients were divided according to adequateness of BCG treatment, defined as at least five of six instillations of induction and at least two of three instillations of maintenance, as recommended by the International Bladder Cancer Group (IBCG). The endpoint of this study was to estimate the 5-year recurrence-free survival and 5-year progression-free survival among patients who received adequate vs inadequate BCG therapy. Kaplan-Meyer analysis and multivariable Cox-regression models were fitted to test the effect of BCG treatment adequateness.
Overall, 133 (43%) patients received inadequate treatment according to IBCG. During a median follow-up of 35 months (IQR 19-60), 98 (31.5%) patients experienced a disease recurrence, of which 50 (51%) were treated adequately versus 48 (49%) who were not (p = 0.10).
Similarly, 25 patients (8%) showed progression to muscle-invasive disease, of which 14 (56%) were not treated adequately (p = 0.20). Five-year recurrence-free survival estimates were 72.3% in those who received adequate treatment versus 58.3% in those who did not (p = 0.025):
Similarly, adequately treated patients have a lower five-year progression-free survival compared to their counterparts (90.1% vs. 86.3%, respectively, p = 0.049):
In multivariable models, inadequate treatment independently predicted disease recurrence (HR 2.20, 95% CI 1.33-3.91, p = 0.003) and progression (HR 1.60, 95% CI 1.05-2.47, p = 0.02) after adjusting for age, EAU risk category, eventual concomitant CIS at first TURBT and eventual second look.
Dr. de Angelis concluded his presentation by discussing cancer control rates in adequate versus inadequate treatment with adjuvant immunotherapy instillations with BCG with the following take-home messages:
- Patients with adequate BCG treatment according to IBCG have a lower risk of recurrence and progression relative to those treated inadequately
- Thus, patients unable to receive adequate BCG instillations have lower cancer control rates and are more likely to undergo radical cystectomy
Presented by: Mario de Angelis, MD, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2024 American Urological Association (AUA) Annual Meeting, San Antonio, TX, Fri, May 3 – Mon, May 6, 2024.