Advertisement

International Journal of Clinical Oncology

, Volume 17, Issue 5, pp 477–481 | Cite as

Single monthly bacillus Calmette-Guérin intravesical instillation is effective maintenance therapy to prevent recurrence in Japanese patients with non-muscle-invasive bladder cancer

  • Takehiko OkamuraEmail author
  • Hidetoshi Akita
  • Ryosuke Ando
  • Yosuke Ikegami
  • Taku Naiki
  • Noriyasu Kawai
  • Keiichi Tozawa
  • Kenjiro Kohri
Original Article

Abstract

Background

A series of bacillus Calmette-Guérin (BCG) bladder instillations is the gold standard therapy to prevent recurrence after transurethral resection of bladder tumor (TUR-Bt) of non-muscle-invasive bladder cancer (NMIBC). However, in some cases the outcome is not optimal with the standard 6- to 8-week protocol and therefore interest has focused on additional maintenance therapy. The present study was conducted to assess the utility of single monthly intravesical instillation treatments for up to 1 year in Japanese patients.

Methods

A total of 75 stage Ta and T1 patients who had undergone TUR-Bt were retrospectively evaluated, all first receiving 80 mg BCG (Tokyo 172 strain) given once a week, 6–8 times, for primary prophylaxis. Comparison was then made of groups with (group A, 48 patients) and without (group B, 27 patients) additional maintenance BCG therapy given once a month 6–8 times.

Results

Recurrence-free survival rates at 5 years in groups A and B were 83.0 and 51.9% (P = 0.006), despite the greater proportion of T1 patients and the longer follow-up period in the group A patients. Significant protection against recurrence persisted on multivariate analysis with adjustment for age, stage, grade, and tumor number.

Conclusions

These findings indicate maintenance BCG therapy of single intravesical instillations given once a month with our protocol to be definitely effective for prophylactic use, especially in stage Ta patients. Further evaluation of parameters such as the continuance period and dose protocol is warranted.

Keywords

Bacillus Calmette-Guérin Non-muscle-invasive bladder cancer Intravesical instillation Maintenance therapy 

Notes

Conflict of interest

None declared.

References

  1. 1.
    Sylvester RJ, van der Meijden AP, Lamm DL (2002) Intravesical bacillus Calmette–Guerin reduces the risk of progression in patients with superficial bladder cancer: a meta-analysis of the published results of randomized clinical trials. J Urol 168:1964–1970PubMedCrossRefGoogle Scholar
  2. 2.
    Sarosdy MF, Lamm DL (1989) Long-term results of intravesical bacillus Calmette–Guérin therapy for superficial bladder cancer. J Urol 142:719–722PubMedGoogle Scholar
  3. 3.
    Cookson MS, Sarosdy MF (1992) Management of stage T1 superficial bladder cancer with intravesical bacillus Calmette–Guérin therapy. J Urol 148:797–801PubMedGoogle Scholar
  4. 4.
    Margel D, Tal R, Golan S et al (2007) Long-term follow-up of patients with stage T1 high grade transitional cell carcinoma managed by bacillus Calmette–Guérin immunotherapy. Urology 69:78–82PubMedCrossRefGoogle Scholar
  5. 5.
    Okamura T, Tozawa K, Yamada Y et al (1996) Clinicopathological evaluation of repeated courses of intravesical bacillus Calmette–Guérin instillation for preventing the recurrence of initially resistant superficial bladder cancers. J Urol 156:967–969PubMedCrossRefGoogle Scholar
  6. 6.
    Gårdmark T, Jahnson S, Wahlquist R et al (2007) Analysis of progression and survival after 10 years of a randomized prospective study comparing mitomycin-C and bacillus Calmette–Guérin in patients with high-risk bladder cancer. BJU Int 99:817–820PubMedCrossRefGoogle Scholar
  7. 7.
    Lamm DL, Blumenstein BA, Crissman JD et al (2000) Maintenance bacillus Calmette–Guérin immunotherapy for recurrent Ta, T1 and carcinoma in situ transitional cell carcinoma of the bladder cancer: a randomized Southwest Oncology Group Study. J Urol 163:1124–1129PubMedCrossRefGoogle Scholar
  8. 8.
    Badalament RA, Herr HW, Won GY et al (1987) A prospective randomized trial of maintenance versus nonmaintenance intravesical bacillus Calmette–Guerin therapy of superficial bladder cancer. J Clin Oncol 5:441–449PubMedGoogle Scholar
  9. 9.
    Bedeir AED, Sarhan O, Nabeeh A et al (2007) Maintenance intravesical BCG therapy for superficial bladder tumours: 3 week multiple courses versus monthly doses. J Urol 177(4):522 (Abstract 1579)Google Scholar
  10. 10.
    Koga H, Ozono S, Tsushima T et al (2010) Maintenance intravesical bacillus Calmette–Guerin instillation for Ta, T1 cancer and carcinoma in situ of the bladder: randomized controlled trial by the BCG Tokyo Strain Study Group. Int J Urol 17:759–767PubMedCrossRefGoogle Scholar
  11. 11.
    Hinotsu S, Akaza H, Naito S et al (2011) Maintenance therapy with bacillus Calmette–Guérin Connaught strain clearly prolongs recurrence-free survival following transurethral resection of bladder tumour for non-muscle-invasive bladder cancer. BJU Int 107:1–9Google Scholar
  12. 12.
    (2001) 3rd edition of the General rules for clinical and pathological studies on bladder cancer of the Japanese Urological Association and the Japanese Society of Pathology. Kanehara & Co., Ltd, TokyoGoogle Scholar
  13. 13.
    Okamura T, Akita H, Hashimoto Y et al (2010) Non muscle invasive bladder cancer cases initially failing to respond to bacillus Calmette–Guérin intravesical instillation therapy. Curr Urol 4:18–24CrossRefGoogle Scholar
  14. 14.
    Herr HW (2008) Is maintenance bacillus Calmette–Guérin really necessary? Eur Urol 54:971–973PubMedCrossRefGoogle Scholar

Copyright information

© Japan Society of Clinical Oncology 2011

Authors and Affiliations

  • Takehiko Okamura
    • 1
    Email author
  • Hidetoshi Akita
    • 1
  • Ryosuke Ando
    • 1
  • Yosuke Ikegami
    • 2
  • Taku Naiki
    • 2
  • Noriyasu Kawai
    • 2
  • Keiichi Tozawa
    • 2
  • Kenjiro Kohri
    • 2
  1. 1.Department of UrologyJ.A. Aichi Anjo Kosei HospitalAnjoJapan
  2. 2.Department of Nephro-UrologyNagoya City University Graduate School of Medical SciencesNagoyaJapan

Personalised recommendations