To quantify the oncological risks of bladder-sparing therapy (BST) in patients with Bacillus Calmette-Guérin (BCG)-unresponsive non-muscle-invasive bladder cancer (NMIBC) compared to upfront radical cystectomy (RC).
Pre-specified data elements were collected from retrospective cohorts of patients with BCG-unresponsive NMIBC from 10 international sites. After Institutional Review Board approval, patients were included if they had BCG-unresponsive NMIBC meeting United States Food and Drug Administration criteria. Oncological outcomes were collected following upfront RC or BST. BST regimens included re-resection or surveillance only, repeat BCG, intravesical chemotherapy, systemic immunotherapy, and clinical trials.
Among 578 patients, 28% underwent upfront RC and 72% received BST. The median (interquartile range) follow-up was 50 (20-69) months. There were no statistically significant differences in metastasis-free survival, cancer-specific survival, or overall survival between treatment groups. In the BST group, high-grade recurrence rates were 37% and 52% at 12 and 24 months and progression to MIBC was observed in 7% and 13% at 12 and 24 months, respectively. RC was performed in 31.7% in the BST group and nodal disease was found in 13% compared with 4% in upfront RC (P = 0.030).
In a selected cohort of patients, initial BST offers comparable survival outcomes to upfront RC in the intermediate term. Rates of recurrence and progression increase over time especially in patients treated with additional lines of BST.
BJU international. 2024 Aug 25 [Epub ahead of print]
Jacob I Taylor, Ashish M Kamat, Michael A O'Donnell, Drupad Annapureddy, Jeffrey Howard, Wei Shen Tan, Ian McElree, Facundo Davaro, Kendrick Yim, Stephen Harrington, Elizabeth Dyer, Anna J Black, Pratik Kanabur, Mathieu Roumiguié, Seth Lerner, Peter C Black, Jay D Raman, Mark A Preston, Gary Steinberg, William Huang, Roger Li, Vignesh T Packiam, Solomon L Woldu, Yair Lotan
University of Texas Southwestern Medical Center, Dallas, TX, USA., University of Texas MD Anderson Cancer Center, Houston, TX, USA., University of Iowa, Iowa City, IA, USA., Moffit Cancer Center, Tampa, FL, USA., Brigham and Women's Hospital, Boston, MA, USA., Penn State Health, Hershey, PA, USA., University of British Columbia, Vancouver, British Columbia, Canada., Baylor College of Medicine, Houston, TX, USA., CHU-Institut Universitaire du Cancer-Oncopôle, Toulouse, France., New York University Langone Health, New York, NY, USA.