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Bacillus calmette-guerin versus chemotherapy for the intravesical treatment of patients with carcinoma in situ of the bladder: a meta-analysis of the published results of randomized clinical trials.

AbstractPURPOSE:
We determined the short-term and long-term efficacy of bacillus Calmette-Guerin (BCG) and chemotherapy in the treatment of patients with carcinoma in situ (CIS).
MATERIALS AND METHODS:
A meta-analysis was performed on published results of randomized clinical trials comparing intravesical BCG to intravesical chemotherapy.
RESULTS:
Nine randomized trials including 700 patients with CIS compared BCG to either mitomycin C (MMC), epirubicin, adriamycin, or sequential MMC/adriamycin. Of 298 patients on BCG 203 (68.1%) had a complete response compared with 158 of 307 patients on chemotherapy (51.5%), a reduction of 47% in the odds of nonresponse on BCG (OR 0.53, p =0.0002). Based on a median followup of 3.6 years, 161 of 345 patients on BCG (46.7%) had no evidence of disease compared with 93 of 355 patients on chemotherapy (26.2%), a reduction of 59% in the odds of treatment failure on BCG (OR 0.41, p <0.0001). Although the long-term benefit of BCG was smaller in trials with MMC, BCG was superior to MMC in trials with maintenance BCG (OR 0.57, p =0.04). The reduction of 26% in the risk of progression on BCG (p =0.20) is consistent with the reduction of 27% (p =0.001) previously reported in a larger superficial bladder cancer meta-analysis.
CONCLUSIONS:
Intravesical BCG significantly reduces the risk of short and long-term treatment failure compared with intravesical chemotherapy. Therefore, it is considered to be the intravesical agent of choice in the treatment of CIS.
AuthorsRichard J Sylvester, Adrian P M van der Meijden, J Alfred Witjes, Karlheinz Kurth
JournalThe Journal of urology (J Urol) Vol. 174 Issue 1 Pg. 86-91; discussion 91-2 (Jul 2005) ISSN: 0022-5347 [Print] United States
PMID15947584 (Publication Type: Comparative Study, Journal Article, Meta-Analysis, Research Support, N.I.H., Extramural, Research Support, U.S. Gov't, P.H.S.)
Chemical References
  • Adjuvants, Immunologic
  • Antineoplastic Agents
  • BCG Vaccine
Topics
  • Adjuvants, Immunologic (administration & dosage)
  • Administration, Intravesical
  • Antineoplastic Agents (administration & dosage)
  • BCG Vaccine (administration & dosage)
  • Carcinoma in Situ (drug therapy)
  • Humans
  • Randomized Controlled Trials as Topic
  • Urinary Bladder Neoplasms (drug therapy)

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