Researchers collected data from 22 patients with histologically proven UTcis. The median age of patients was 71 years, and 81.8% were male. History of bladder cancer and bladder carcinoma in situ was present in 86.4% and 81.8% of patients, respectively. All patients received first-line BCG treatment, and 91.3% completed the 6-week instillation cycle. The median follow-up was 40 months, with 8 patients exhibiting recurrence. The 5-year recurrence-free and progression-free survival rates were 49.6% (95% CI, 28.2 – 87.4) and 72.3% (51.3 – 100), respectively. There was no difference in recurrence rate between patients who received retrograde versus anterograde BCG instillation (p = 1). Salvage treatment included RNU in five patients, distal ureterectomy in one patient, and supportive care in two patients. At 28 and 48 months, two patients exhibited recurrence.
Fontanet et al. then systematically reviewed 15 relevant studies on BCG among UTcis patients. The complete response rate varied between 41% and 100% across these retrospective studies. Response evaluation criteria were different across studies. The length of follow-up time was between 16 and 58 months. RNU was the most common salvage treatment, but eleven patients were treated with a second induction course of BCG. This resulted in a response rate of 18%. BCG-related adverse events varied from 0% to 92%, with mild symptoms representing a third of these (cystitis, fever, storage disorders).
This study fills a critical gap in UTcis literature. Many factors contribute to the challenge of generating a consensus on the efficacy of emerging treatments in UTcis patients, such as insufficient sample sizes and critical differences in assessing treatment response. Moreover, treatment-related variables, including BCG strain, number of doses, and instillation technique, are highly heterogeneous across studies. This emphasizes the need for additional standardized and robust future studies.
Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine
References:
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Fontanet S, Gallioli A, Baboudjian M, et al. Topical instillation of BCG immunotherapy for biopsy-proven primary upper urinary tract carcinoma in situ: A single institution series and systematic review. Urol Oncol. 2023;41(6U):274-283. doi:10.1016/j.urolonc.2022.11.001