Journal Article

Compared Efficacy of Adjuvant Intravesical BCG-TICE vs. BCG-RIVM for High-Risk Non-Muscle Invasive Bladder Cancer (NMIBC): A Propensity Score Matched Analysis

Flammia, Rocco Simone, Cattarino, Susanna, Carrieri, Giuseppe, Mertens, Laura S., Bettocchi, Carlo, Asero, Vincenzo, Ferro, Matteo, Soria, Francesco, Cacciamani, Giovanni E., D’Altilia, Nicola, Krajewski, Wojciech, De Angelis, Mario, Albisinni, Simone, Laukhtina, Ekaterina, Falagario, Ugo Giovanni, Autorino, Riccardo, Maggi, Martina, Cinelli, Francesco, Szydełko, Tomasz, De Berardinis, Ettore, Sciarra, Alessandro, Chirico, Marco, Scornajenghi, Carlo Maria, Pandolfo, Savio Domenico, D’Andrea, David, Busetto, Gian Maria, Mari, Andrea, Gallioli, Andrea, Del Giudice, Francesco, Moschini, Marco, Salciccia, Stefano, Cormio, Luigi, Pradere, Benjamin, Chung, Benjamin I., Mancini, Vito

2022

Overview

Background: Intravesical immunotherapy with bacillus Calmette–Guerin (BCG) is the standard therapy for high-risk non-muscle invasive bladder cancer (NMIBC). The superiority of any BCG strain over another could not be demonstrated yet. Methods: Patients with NMIBCs underwent adjuvant induction ± maintenance schedule of intravesical immunotherapy with either BCG TICE or RIVM at two high-volume tertiary institutions. Only BCG-naïve patients and those treated with the same strain over the course of follow-up were included. One-to-one (1:1) propensity score matching (PSM) between the two cohorts was utilized to adjust for baseline demographic and tumor characteristics imbalances. Kaplan–Meier estimates and multivariable Cox regression models according to high-risk NMIBC prognostic factors were implemented to address survival differences between the strains. Sub-group analysis modeling of the influence of routine secondary resection (re-TUR) in the setting of the sole maintenance adjuvant schedule for the two strains was further performed. Results: 852 Ta-T1 NMIBCs (n = 719, 84.4% on TICE; n = 133, 15.6% on RIVM) with a median of 53 (24–77) months of follow-up were reviewed. After PSM, no differences at 5-years RFS, PFS, and CSS at both Kaplan–Meier and Cox regression analyses were detected for the whole cohort. In the sub-group setting of full adherence to European/American Urology Guidelines (EAU/NCCN), BCG TICE demonstrated longer 5-years RFS compared to RIVM (68% vs. 43%, p = 0.008; HR: 0.45 95% CI 0.25–0.81). Conclusion: When routinely performing re-TUR followed by a maintenance BCG schedule, TICE was superior to RIVM for RFS outcomes. However, no significant differences were detected for PFS and CSS, respectively.

• Publisher: MDPI AG,MDPI
• Subject: Bladder cancer / Cancer / Cancer therapies / Clinical trials / Immunotherapy / Invasiveness / Medical prognosis / Regression analysis / Schedules / Survival / Tumors