Intravesical chemotherapy plus bacille Calmette-Guerin in non-muscle invasive bladder cancer: a systematic review with meta-analysis

被引：42

作者：

Houghton, Baerin B. ^{[1
,3
]}

Chalasani, Venu ^{[1
,3
,4
]}

Hayne, Dickon ^{[7
]}

Grimison, Peter ^{[5
]}

Brown, Christopher S. B. ^{[1
]}

Patel, Manish I. ^{[2
]}

Davis, Ian D. ^{[3
,6
]}

Stockler, Martin R. ^{[1
,5
]}

机构：

[1] Univ Sydney, NHMRC Clin Trials Ctr, Sydney, NSW 2006, Australia

[2] Univ Sydney, Urol Canc Outcomes Ctr, Sydney, NSW 2006, Australia

[3] Australian & New Zealand Urogenital & Prostate AN, Sydney, NSW, Australia

[4] Northern Sydney Local Hlth Dist, Sydney, NSW, Australia

[5] Sydney Canc Ctr, Sydney, NSW, Australia

[6] Monash Univ, Melbourne, Vic 3004, Australia

[7] Univ Western Australia, Sch Surg, Perth, WA 6009, Australia

来源：

BJU INTERNATIONAL | 2013年 / 111卷 / 06期

关键词：

urinary bladder neoplasm; BCG vaccine; mitomycin C; epirubicin; intravesical administration; TRANSITIONAL-CELL CARCINOMA; IN-SITU; IMMUNOTHERAPY; PROGRESSION; EPIRUBICIN; MITOMYCIN; RECURRENT; EFFICACY; TUMORS; BCG;

D O I：

10.1111/j.1464-410X.2012.11390.x

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

What's known on the subject? and What does the study add? Non-muscle-invasive bladder cancer has a significant recurrence and progression rate despite transurethral resection. The current standard of care to lower the risk of recurrence and progression is adjuvant BCG followed by maintenance BCG. Despite this, a significant number of patients experience recurrence and progress to invasive cancer. Several randomized trials have studied combination therapy (BCG with chemotherapy) to try to reduce the recurrence and progression rate. We performed a systematic review with meta-analysis and found that adjuvant BCG followed by maintenance therapy is the appropriate standard of care when compared with combination therapy. We conclude that further trials are warranted to test the effects of adding chemotherapy to BCG in patients with Ta or T1 disease, but not in those with Tis alone. Objective To determine if the combination of intravesical chemotherapy and maintenance bacille Calmette-Guerin (BCG), used in sequence, is superior to maintenance BCG alone in the treatment of non-muscle-invasive bladder cancer (NMIBC). Methods We searched biomedical literature databases for randomized controlled trials that compared sequential, intravesical chemotherapy added to maintenance BCG with maintenance BCG alone. Studies that did not use maintenance BCG were excluded. The meta-analysis was performed using the fixed effects model. Results Four trials were identified, including 801 patients. Adding chemotherapy to maintenance BCG did not result in a significant reduction in recurrence (relative risk [RR] 0.92; 95% confidence interval [CI] 0.791.09; P = 0.32) or progression (RR 0.88; 95% CI 0.611.27; P = 0.5). The risk of recurrence (RR 0.75; 95% CI 0.610.92; P = 0.006) and progression (RR 0.45; 95% CI 0.250.81; P = 0.007) were reduced when the single trial that included isolated Tis was excluded. Toxicity was similar for both groups. Conclusions Adjuvant therapy with induction BCG followed by maintenance BCG is the appropriate standard of care for patients with resected NMIBC at high risk of recurrence. Further trials are warranted to test the effects of adding chemotherapy to BCG in patients with Ta or T1 disease, but not in those with Tis alone.

引用

页码：977 / 983

页数：7

共 20 条

[1] Sequential bacillus Calmette-Guerin and epirubicin versus bacillus Calmette-Guerin alone for superficial bladder tumors: A randomized prospective study [J].