Bacillus Calmette-Guérin (BCG) reduces disease recurrence and progression in intermediate- and high-risk non-muscle-invasive bladder cancer (NMIBC). BCG-associated adverse events during instillations are common, leading to treatment cessation. Prophylactic use of quinolones in conjunction with BCG instillations is one approach for reducing BCG-associated adverse events. Our aim was to delineate the clinical impact of quinolone prophylaxis (QP) in patients receiving adjuvant BCG instillations for NMIBC.
In October 2024, a systematic search of MEDLINE, Embase, and the Cochrane Central Register of controlled trials was performed. Prospective and retrospective studies reporting comparative outcomes for patients with and without QP during BCG instillations were included. Outcomes were reported in a binary fashion. Random-effects meta-analysis using the weighted mean difference was conducted. Primary outcomes for pooled analyses included BCG-associated toxicities, the completion rate for BCG induction, the likelihood of antituberculosis treatment, and disease recurrence and progression at 12 mo.
The systematic review included five studies. Four randomised controlled trials were included in the meta-analysis, and one nonrandomised study was also included in the narrative review. The studies involved 445 patients, of whom 194 received QP + BCG and 251 received BCG alone. QP use was associated with lower incidence of class ≥2 (40.8% vs 54.7%; relative risk [RR] 0.79, 95% confidence interval [CI] 0.67-0.94; p = 0.006), and class ≥3 BCG-associated toxicities (25.3% vs 36.4%; RR 0.70, 95% CI 0.50-0.98; p = 0.04) and a higher completion rate for BCG induction (83.0% vs 70.6%; RR 1.16, 95% CI 1.01-1.34; p = 0.04). The 12-mo recurrence rates (14.7% vs 19.4%; RR 0.76, 95% CI 0.46-1.27; p = 0.3) and progression rates (4.5% vs 6.4%; RR 0.86, 95% CI 0.09-8.25; p = 0.9) did not significantly differ for QP + BCG versus BCG alone.
The use of QP with adjuvant BCG for NMIBC mitigated debilitating BCG-associated toxicities and improved the completion rate for BCG induction therapy.
European urology oncology. 2025 Jan 28 [Epub ahead of print]
Chris Ho-Ming Wong, Ivan Ching-Ho Ko, David Ka-Wai Leung, Steffi Kar-Kei Yuen, Brian Siu, Yuhong Yuan, Alison Birtle, Otakar Capoun, Eva Compérat, José L Domínguez-Escrig, Fredrik Liedberg, Paramananthan Mariappan, Marco Moschini, Benjamin Pradere, Bhavan P Rai, Bas W G van Rhijn, Thomas Seisen, Shahrokh F Shariat, Francesco Soria, Viktor Soukup, Evanguelos N Xylinas, Alexandra Masson-Lecomte, Paolo Gontero, Steven Leung, Jeremy Yuen-Chun Teoh
S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China., Department of Medicine, London Health Science Centre, London, Canada; Department of Medicine, McMaster University Health Science Centre, Hamilton, Canada., Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK; University of Manchester, Manchester, UK., Department of Urology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia., Department of Pathology, Medical University of Vienna, Vienna, Austria., Jefe Clínico Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain., Department of Urology Skåne University Hospital, Malmö, Sweden; Institute of Translational Medicine, Lund University, Malmö, Sweden., Edinburgh Bladder Cancer Surgery, Department of Urology, Western General Hospital, Edinburgh, UK., Department of Urology, San Raffaele Hospital, Milan, Italy., Department of Urology, UROSUD, La Croix du Sud Hôpital, Quint Fonsegrives, France., Department of Urology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK., Surgical Oncology (Urology), Netherlands Cancer Institute, The Netherlands., Department of Urology, Pitié-Salpêtrière Hospital, AP-HP, GRC 5 Predictive Onco-Urology, Sorbonne University, Paris, France., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy., Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University in Praha, Praha, Czechia., Department of Urology, Hopital Bichat-Claude Bernard, AP-HP, Université de Paris Cité, Paris, France., Department of Urology, Saint Louis Hospital, AP-HP, Université de Paris, Paris, France., S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Sciences, Chinese University of Hong Kong, Hong Kong, China; Department of Urology, Medical University of Vienna, Austria, Vienna. Electronic address: .