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Kawada T, Yanagisawa T, Bekku K, Laukhtina E, von Deimling M, Chlosta M, Pradere B, Teoh JYC, Babjuk M, Araki M, Shariat SF. The efficacy and safety outcomes of lower dose BCG compared to intravesical chemotherapy in non-muscle-invasive bladder cancer: A network meta-analysis. Urol Oncol 2023:S1078-1439(23)00118-7. [PMID: 37137745 DOI: 10.1016/j.urolonc.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/01/2023] [Indexed: 05/05/2023]
Abstract
This study aimed to assess both efficacy and safety outcomes of lowering the dose of BCG compared to intravesical chemotherapies in non-muscle-invasive bladder cancer (NMIBC) patients using a systematic review, meta-analysis, and network meta-analysis approach. A comprehensive literature search was performed through Pubmed®, Web of Science™, and Scopus® in December 2022 to identify randomized controlled trials comparing the oncologic and/or safety outcomes of reduced dose intravesical BCG and/or intravesical chemotherapies according to the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) statement. The outcomes of interest were risk of recurrence, progression, treatment-related adverse events, and discontinuation. Overall, 24 studies were eligible for quantitative synthesis. Among 22 studies that adopted induction followed by maintenance intravesical therapy, with reference to the lower-dose BCG, epirubicin was associated with a significantly higher risk of recurrence (Odds ratio [OR]: 2.82, 95% CI: 1.54-5.15), but not other intravesical chemotherapies. There were no significant differences in risk of progression among the intravesical therapies. On the other hand, standard-dose BCG was associated with a higher risk of any AEs (OR: 1.91, 95% CI: 1.07-3.41) but other intravesical chemotherapies had a comparable risk of AEs compared to lower-dose BCG. The discontinuation rate did not significantly differ between lower-dose and standard-dose BCG (OR: 1.40, 95% CI: 0.81-2.43) as well as other intravesical. According to the surface under the cumulative ranking curve, gemcitabine, and standard-dose BCG were preferable to lower-dose BCG in terms of recurrence risk; gemcitabine was also preferable to lower-dose BCG in terms of risk of AEs. In patients with NMIBC, lowering the dose of BCG decreases the risks of AEs and discontinuation rate compared to standard-dose BCG, but there is no difference in these endpoints compared to other intravesical chemotherapies. Standard-dose of BCG is preferred for all intermediate and high-risk NMIBC patients based on oncologic efficacy; however, lower-dose BCG and intravesical chemotherapies, especially gemcitabine, could be considered a reasonable alternative to BCG in selected patients who suffer from significant AEs or in case standard-dose BCG is not available.
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Affiliation(s)
- Tatsushi Kawada
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takafumi Yanagisawa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kensuke Bekku
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Markus von Deimling
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marcin Chlosta
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Jagiellonian University Medical College, Cracow, Poland
| | - Benjamin Pradere
- Department of Urology UROSUD, La Croix Du Sud Hospital, Quint Fonsegrives, France
| | - Jeremy Yuen-Chun Teoh
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Marko Babjuk
- Department of Urology, Second Faculty of Medicine of Charles University, University Hospital Motol, Prague, Czech Republic
| | - Motoo Araki
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Division of Urology, Department of Special Surgery, The University of Jordan, Amman, Jordan; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.
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Gupta S, Dutta A, Pal DK. Comparison of intravesical adjuvant therapy in bladder cancer with two different maintenance regimens of mitomycin and BCG. Urologia 2021; 89:53-57. [PMID: 34668805 DOI: 10.1177/03915603211050783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare recurrence rate and side effects with two different maintenance regimens of postoperative intravesical therapy with mitomycin and BCG in T1 bladder cancer. METHODS Eighty were enrolled in this study and all received immediate post operative mitomycin. They were then allocated to two groups of 40, one group receiving intravesicle BCG and other a combination BCG and Mitomycin. They were followed up to a period of 2 years. RESULT Two year recurrence rate after transurethral resection of bladder tumour with high grade T1 disease in the Combination group is low (20%) as compared to the BCG group (37.5%). CONCLUSION Two year recurrences reduced with use of intravesical Mitomycin during maintenance in the combination group which though not statistically significant favours the trial with combination therapy in future studies. Side effect profile did not worsen with combination of Mitomycin and BCG.
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Affiliation(s)
- Sandeep Gupta
- Department of Urology, Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, West Bengal, India
| | - Avisek Dutta
- Department of Urology, Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, West Bengal, India
| | - Dilip Kumar Pal
- Department of Urology, Institute of Post Graduate Medical Education and Research (IPGME&R), Kolkata, West Bengal, India
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Schmidt S, Kunath F, Coles B, Draeger DL, Krabbe L, Dersch R, Kilian S, Jensen K, Dahm P, Meerpohl JJ. Intravesical Bacillus Calmette-Guérin versus mitomycin C for Ta and T1 bladder cancer. Cochrane Database Syst Rev 2020; 1:CD011935. [PMID: 31912907 PMCID: PMC6956215 DOI: 10.1002/14651858.cd011935.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND People with urothelial carcinoma of the bladder are at risk for recurrence and progression following transurethral resection of a bladder tumour (TURBT). Mitomycin C (MMC) and Bacillus Calmette-Guérin (BCG) are commonly used, competing forms of intravesical therapy for intermediate- or high-risk non-muscle invasive (Ta and T1) urothelial bladder cancer but their relative merits are somewhat uncertain. OBJECTIVES To assess the effects of BCG intravesical therapy compared to MMC intravesical therapy for treating intermediate- and high-risk Ta and T1 bladder cancer in adults. SEARCH METHODS We performed a systematic literature search in multiple databases (CENTRAL, MEDLINE, Embase, Web of Science, Scopus, LILACS), as well as in two clinical trial registries. We searched reference lists of relevant publications and abstract proceedings. We applied no language restrictions. The latest search was conducted in September 2019. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared intravesical BCG with intravesical MMC therapy for non-muscle invasive urothelial bladder cancer. DATA COLLECTION AND ANALYSIS Two review authors independently screened the literature, extracted data, assessed risk of bias and rated the quality of evidence according to GRADE per outcome. In the meta-analyses, we used the random-effects model. MAIN RESULTS We identified 12 RCTs comparing BCG versus MMC in participants with intermediate- and high-risk non-muscle invasive bladder tumours (published from 1995 to 2013). In total, 2932 participants were randomised. Time to death from any cause: BCG may make little or no difference on time to death from any cause compared to MMC (hazard ratio (HR) 0.97, 95% confidence interval (CI) 0.79 to 1.20; participants = 1132, studies = 5; 567 participants in the BCG arm and 565 in the MMC arm; low-certainty evidence). This corresponds to 6 fewer deaths (40 fewer to 36 more) per 1000 participants treated with BCG at five years. We downgraded the certainty of the evidence two levels due to study limitations and imprecision. Serious adverse effects: 12/577 participants treated with BCG experienced serious non-fatal adverse effects compared to 4/447 participants in the MMC group. The pooled risk ratio (RR) is 2.31 (95% CI 0.82 to 6.52; participants = 1024, studies = 5; low-certainty evidence). Therefore, BCG may increase the risk for serious adverse effects compared to MMC. This corresponds to nine more serious adverse effects (one fewer to 37 more) with BCG. We downgraded the certainty of the evidence two levels due to study limitations and imprecision. Time to recurrence: BCG may reduce the time to recurrence compared to MMC (HR 0.88, 95% CI 0.71 to 1.09; participants = 2616, studies = 11, 1273 participants in the BCG arm and 1343 in the MMC arm; low-certainty evidence). This corresponds to 41 fewer recurrences (104 fewer to 29 more) with BCG at five years. We downgraded the certainty of the evidence two levels due to study limitations, imprecision and inconsistency. Time to progression: BCG may make little or no difference on time to progression compared to MMC (HR 0.96, 95% CI 0.73 to 1.26; participants = 1622, studies = 6; 804 participants in the BCG arm and 818 in the MMC arm; low-certainty evidence). This corresponds to four fewer progressions (29 fewer to 27 more) with BCG at five years. We downgraded the certainty of the evidence two levels due to study limitations and imprecision. Quality of life: we found very limited data for this outcomes and were unable to estimate an effect size. AUTHORS' CONCLUSIONS Based on our findings, BCG may reduce the risk of recurrence over time although the Confidence Intervals include the possibility of no difference. It may have no effect on either the risk of progression or risk of death from any cause over time. BCG may cause more serious adverse events although the Confidence Intervals once again include the possibility of no difference. We were unable to determine the impact on quality of life. The certainty of the evidence was consistently low, due to concerns that include possible selection bias, performance bias, given the lack of blinding in these studies, and imprecision.
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Affiliation(s)
- Stefanie Schmidt
- UroEvidence@Deutsche Gesellschaft für UrologieMartin‐Buber‐Str. 10BerlinGermany14163
| | - Frank Kunath
- UroEvidence@Deutsche Gesellschaft für UrologieMartin‐Buber‐Str. 10BerlinGermany14163
- University Hospital ErlangenDepartment of UrologyKrankenhausstrasse 12ErlangenGermany91054
| | - Bernadette Coles
- Cardiff University Library ServicesVelindre NHS TrustVelindre Cancer CentreWhitchurchCardiffUKCF14 2TL
| | - Desiree Louise Draeger
- UroEvidence@Deutsche Gesellschaft für UrologieMartin‐Buber‐Str. 10BerlinGermany14163
- University of RostockDepartment of UrologyErnst‐Heydemann‐Strasse 7RostockMecklenburg‐VorpommernGermany18057
| | - Laura‐Maria Krabbe
- UroEvidence@Deutsche Gesellschaft für UrologieMartin‐Buber‐Str. 10BerlinGermany14163
- University of Muenster Medical CenterDepartment of UrologyAlbert‐Schweitzer Campus 1, GB A1MuensterNRWGermany48149
| | - Rick Dersch
- Medical Center – University of FreiburgDepartment of Neurology and NeurophysiologyBerliner Allee 29FreiburgGermany79110
| | - Samuel Kilian
- University of HeidelbergInstitute of Medical Biometry and InformaticsHeidelbergGermany
| | - Katrin Jensen
- University of HeidelbergInstitute of Medical Biometry and InformaticsHeidelbergGermany
| | - Philipp Dahm
- Minneapolis VA Health Care SystemUrology SectionOne Veterans DriveMail Code 112DMinneapolisMinnesotaUSA55417
- University of MinnesotaDepartment of Urology420 Delaware Street SEMMC 394MinneapolisMinnesotaUSA55455
| | - Joerg J Meerpohl
- Medical Center ‐ University of Freiburg, Faculty of Medicine, University of
FreiburgInstitute for Evidence in MedicineBreisacher Str. 153FreiburgGermanyD‐79110
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Zhuo C, Li X, Zhuang H, Tian S, Cui H, Jiang R, Liu C, Tao R, Lin X. Evaluating the efficacy and safety of intravesical chemotherapies for non-muscle invasive bladder cancer: a network meta-analysis. Oncotarget 2018; 7:82567-82579. [PMID: 27788495 PMCID: PMC5347714 DOI: 10.18632/oncotarget.12856] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 10/04/2016] [Indexed: 11/25/2022] Open
Abstract
Various intravesical therapies have been introduced into clinical practices for controlling non-muscle invasive bladder cancer (NMIBC). However, evidence with respect to the efficacy and safety of those intravesical therapies is very limited. Hence, we present a network meta-analysis in order to address this limitation in the current literature. The primary outcomes were the risk of tumor recurrence (TR), tumor progression (TP) and disease-specific mortality (DM). Secondary outcomes included the risk of fever, cystitis and haematuria. Conventional pair-wise and network meta-analysis were both performed for each endpoint. The surface under the cumulative ranking curve (SUCRA) was incorporated in our analysis for ranking the corresponding intravesical instillation interventions. In total, 23 randomized clinical trials (RCTs) were finally included in our study after irrelevant papers were screened out. Results of network meta-analysis suggested that Epirubicin (EPI) was less preferable than Bacille Calmette Guerin (BCG), BCG+EPI, BCG+ Isoniazid (INH), BCG+ Mytomicin C (MMC), Gemcitabine (GEM) and MMC with respect to TR. As suggested by the corresponding ranking probabilities and SUCRA, incorporating EPI or MMC into BCG may enhance the efficacy of BCG monotherapy.
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Affiliation(s)
- Chuanjun Zhuo
- Department of Psychological Medicine, Wenzhou Seventh People's Hospital, Wenzhou, Zhejiang, 325005, China.,Department of Psychological Medicine, Jining Medical University, Jining, Shandong, 272067, China.,Department of Psychological Medicine, Tianjin Anding Hospital, Tianjin, 300222, China
| | - Xubin Li
- Department of Radiotherapy, Tianjin Cancer Institute & Hospital, Tianjin, 30000, China
| | - Hongqing Zhuang
- Department of Radiotherapy, Tianjin Cancer Institute & Hospital, Tianjin, 30000, China
| | - Shunli Tian
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin, 300075, China
| | - Hailong Cui
- Intensive Care Unit, Tianjin Medical University General Hospital, Tianjin, 300075, China
| | - Ronghuan Jiang
- Department of Psychological Medicine, Chinese PLA (People's Liberation Army) General Hospital; Chinese PLA (People's Liberation Army) Medical School, Beijing, 100853, China
| | - Chuanxin Liu
- Department of Psychological Medicine, Jining Medical University, Jining, Shandong, 272067, China
| | - Ran Tao
- Beijing Shijian Integrated Medicine Science Institute, Beijing, 100700, China
| | - Xiaodong Lin
- Department of Psychological Medicine, Wenzhou Seventh People's Hospital, Wenzhou, Zhejiang, 325005, China
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5
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Kamat AM, Bellmunt J, Galsky MD, Konety BR, Lamm DL, Langham D, Lee CT, Milowsky MI, O'Donnell MA, O'Donnell PH, Petrylak DP, Sharma P, Skinner EC, Sonpavde G, Taylor JA, Abraham P, Rosenberg JE. Society for Immunotherapy of Cancer consensus statement on immunotherapy for the treatment of bladder carcinoma. J Immunother Cancer 2017; 5:68. [PMID: 28807024 PMCID: PMC5557323 DOI: 10.1186/s40425-017-0271-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 07/25/2017] [Indexed: 12/21/2022] Open
Abstract
The standard of care for most patients with non-muscle-invasive bladder cancer (NMIBC) is immunotherapy with intravesical Bacillus Calmette-Guérin (BCG), which activates the immune system to recognize and destroy malignant cells and has demonstrated durable clinical benefit. Urologic best-practice guidelines and consensus reports have been developed and strengthened based on data on the timing, dose, and duration of therapy from randomized clinical trials, as well as by critical evaluation of criteria for progression. However, these reports have not penetrated the community, and many patients do not receive appropriate therapy. Additionally, several immune checkpoint inhibitors have recently been approved for treatment of metastatic disease. The approval of immune checkpoint blockade for patients with platinum-resistant or -ineligible metastatic bladder cancer has led to considerations of expanded use for both advanced and, potentially, localized disease. To address these issues and others surrounding the appropriate use of immunotherapy for the treatment of bladder cancer, the Society for Immunotherapy of Cancer (SITC) convened a Task Force of experts, including physicians, patient advocates, and nurses, to address issues related to patient selection, toxicity management, clinical endpoints, as well as the combination and sequencing of therapies. Following the standard approach established by the Society for other cancers, a systematic literature review and analysis of data, combined with consensus voting was used to generate guidelines. Here, we provide a consensus statement for the use of immunotherapy in patients with bladder cancer, with plans to update these recommendations as the field progresses.
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Affiliation(s)
- Ashish M Kamat
- University of Texas MD Anderson Cancer Center, 1515 Pressler Unit 1373, Houston, TX, 77030, USA.
| | | | - Matthew D Galsky
- Tisch Cancer Institute at Mount Sinai Medical Center, New York, NY, 10029, USA
| | | | | | - David Langham
- Bladder Cancer Advocacy Network, North Carolina Triangle Chapter, Chapel Hill, NC, 27517, USA
| | - Cheryl T Lee
- The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | | | | | | | | | - Padmanee Sharma
- University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | | | | | - John A Taylor
- University of Kansas Cancer Center, Kansas City, KS, 66160, USA
| | - Prasanth Abraham
- University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
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6
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Deng T, Liu B, Duan X, Zhang T, Cai C, Zeng G. Systematic Review and Cumulative Analysis of the Combination of Mitomycin C plus Bacillus Calmette-Guérin (BCG) for Non-Muscle-Invasive Bladder Cancer. Sci Rep 2017; 7:3172. [PMID: 28600516 PMCID: PMC5466691 DOI: 10.1038/s41598-017-03421-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 05/05/2017] [Indexed: 11/08/2022] Open
Abstract
This systematic review and cumulative analysis aimed to explore the efficacy and safety of the combination of intravesical mitomycin C (MMC) plus bacillus Calmette-Guerin (BCG) for non-muscle-invasive bladder cancer (NMIBC) patients. A comprehensive literature search using Pubmed, Embase, Medline, Cochrane Library, CBM, CNKI and VIP databases was performed to identify studies applying intravesical MMC plus BCG therapy on NMIBC patients up to June 2016. Summarized unadjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to assess the efficacy and safety of the combination therapy. A total of 25 studies containing 2749 NMIBC patients were included in this systematic review. Compared with BCG monotherapy, the combination therapy could significantly reduce the tumor recurrence rate (OR = 0.64, 95% CI: 0.44-0.94, P = 0.02) and cancer-specific mortality (OR = 0.54, 95% CI: 0.34-0.87, P = 0.01), without more toxicities (OR = 0.58, 95% CI: 0.17-1.94, P = 0.37). The combination therapy could also lead to significant lower tumor recurrence rate than MMC monotherapy (OR = 0.41, 95% CI: 0.24-0.69, P = 0.0009). Our study indicates that the combination of MMC plus BCG instillation is an effective and safe adjuvant treatment for NMIBC patients.
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Affiliation(s)
- Tuo Deng
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Guangzhou Institute of Urology, Guangzhou, China
- Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Bing Liu
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xiaolu Duan
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Guangzhou Institute of Urology, Guangzhou, China
- Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Tao Zhang
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Guangzhou Institute of Urology, Guangzhou, China
- Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Chao Cai
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Guangzhou Institute of Urology, Guangzhou, China
- Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Guohua Zeng
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
- Guangzhou Institute of Urology, Guangzhou, China.
- Guangdong Key Laboratory of Urology, Guangzhou, China.
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7
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Hayne D, Stockler M, McCombie SP, Lawrence N, Martin A, Sengupta S, Davis ID. BCG + Mitomycin trial for high-risk non-muscle-invasive bladder cancer: progress report and lessons learned. BJU Int 2017; 119 Suppl 5:55-57. [PMID: 28391606 DOI: 10.1111/bju.13873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Dickon Hayne
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Camperdown, NSW, Australia.,University of Western Australia Medical School, Crawley, WA, Australia.,Fiona Stanley Hospital Urology, Murdoch, WA, Australia
| | - Martin Stockler
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Camperdown, NSW, Australia.,NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Steve P McCombie
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Camperdown, NSW, Australia.,Fiona Stanley Hospital Urology, Murdoch, WA, Australia
| | - Nicola Lawrence
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Camperdown, NSW, Australia.,NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Andrew Martin
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Camperdown, NSW, Australia.,NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Shomik Sengupta
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Camperdown, NSW, Australia.,Department of Urology, Austin Health, Melbourne, Vic., Australia.,Austin Department of Surgery, University of Melbourne, Melbourne, Vic., Australia.,Ludwig Institute for Cancer Research, Austin Hospital, Melbourne, Vic., Australia
| | - Ian D Davis
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Camperdown, NSW, Australia.,Monash University Eastern Health Clinical School, Box Hill, Vic., Australia
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8
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Kaasinen E, Wijkström H, Rintala E, Mestad O, Jahnson S, Malmström PU. Seventeen-year follow-up of the prospective randomized Nordic CIS study: BCG monotherapy versus alternating therapy with mitomycin C and BCG in patients with carcinomain situof the urinary bladder. Scand J Urol 2016; 50:360-8. [DOI: 10.1080/21681805.2016.1210672] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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9
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Järvinen R, Marttila T, Kaasinen E, Rintala E, Aaltomaa S, Kallio J, Liukkonen T, Puolakka VM, Seppänen M, Tuhkanen K, Vaarala M, Viitanen J, Boström PJ. Long-term Outcome of Patients with Frequently Recurrent Non–muscle-invasive Bladder Carcinoma Treated with One Perioperative Plus Four Weekly Instillations of Mitomycin C Followed by Monthly Bacillus Calmette-Guérin (BCG) or Alternating BCG and Interferon-α2b Instillations: Prospective Randomised FinnBladder-4 Study. Eur Urol 2015; 68:611-7. [DOI: 10.1016/j.eururo.2015.02.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 02/18/2015] [Indexed: 11/16/2022]
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10
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Casey RG, Catto JW, Cheng L, Cookson MS, Herr H, Shariat S, Witjes JA, Black PC. Diagnosis and Management of Urothelial Carcinoma In Situ of the Lower Urinary Tract: A Systematic Review. Eur Urol 2015; 67:876-88. [DOI: 10.1016/j.eururo.2014.10.040] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 10/24/2014] [Indexed: 12/28/2022]
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11
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Chen SK, Chung CA, Cheng YC, Huang CJ, Chen WY, Ruaan RC, Li C, Tsao CW, Hu WW, Chien CC. Toll-like receptor 6 and connective tissue growth factor are significantly upregulated in mitomycin-C-treated urothelial carcinoma cells under hydrostatic pressure stimulation. Genet Test Mol Biomarkers 2014; 18:410-6. [PMID: 24689870 DOI: 10.1089/gtmb.2013.0443] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Urothelial carcinoma (UC) is the most common histologic subtype of bladder cancer. The administration of mitomycin C (MMC) into the bladder after transurethral resection of the bladder tumor (TURBT) is a common treatment strategy for preventing recurrence after surgery. We previously applied hydrostatic pressure combined with MMC in UC cells and found that hydrostatic pressure synergistically enhanced MMC-induced UC cell apoptosis through the Fas/FasL pathways. To understand the alteration of gene expressions in UC cells caused by hydrostatic pressure and MMC, oligonucleotide microarray was used to explore all the differentially expressed genes. RESULTS After bioinformatics analysis and gene annotation, Toll-like receptor 6 (TLR6) and connective tissue growth factor (CTGF) showed significant upregulation among altered genes, and their gene and protein expressions with each treatment of UC cells were validated by quantitative real-time PCR and immunoblotting. CONCLUSION Under treatment with MMC and hydrostatic pressure, UC cells showed increasing apoptosis using extrinsic pathways through upregulation of TLR6 and CTGF.
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Affiliation(s)
- Shao-Kuan Chen
- 1 Department of Urology, Sijhih Cathay General Hospital , New Taipei City, Taiwan
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12
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Zhu S, Tang Y, Li K, Shang Z, Jiang N, Nian X, Sun L, Niu Y. Optimal schedule of bacillus calmette-guerin for non-muscle-invasive bladder cancer: a meta-analysis of comparative studies. BMC Cancer 2013; 13:332. [PMID: 23829273 PMCID: PMC3722001 DOI: 10.1186/1471-2407-13-332] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 06/20/2013] [Indexed: 01/08/2023] Open
Abstract
Background To explore the necessity of maintenance, efficacy of low-dose and superiority of various combination therapies of Bacillus Calmette-Guérin (BCG) in treatment of superficial bladder cancer (BCa). Methods Comprehensive searches of electronic databases (PubMed, Embase, and the Cochrane Library) were performed, then a systematic review and cumulative meta-analysis of 21 randomized controlled trials (RCTs) and 9 retrospective comparative studies were carried out according to predefined inclusion criteria. Results Significantly better recurrence-free survivals (RFS) were observed respectively in patients who received BCG maintenance, standard-dose and BCG plus epirubicin therapy comparing to those received induction, low-dose and BCG alone. BCG maintenance therapy was also associated with significantly better progression-free survival (PFS), but there were more incidences of adverse events. Pooled results showed no remarkable advantage of BCG combined with Mitomycin C or with interferon α-2b in improving oncologic outcomes. Sensitivity-analyses stratified by study-design and tumor stage led to very similar overall results and often to a decrease of the between-study heterogeneity. Our data confirmed that non-RCT only affected strength rather than direction of the overall results. Conclusions All patients with superficial BCa should be encouraged to accept BCG maintenance therapy with standard-dose if well tolerated. Patients can benefit from BCG combined with epirubicin but not from BCG combined with Mitomycin C or interferon α-2b.
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Affiliation(s)
- Shimiao Zhu
- Department of Urology, Tianjin Institute of Urology, 2nd Hospital of Tianjin Medical University, Pingjiang Road 23, Tianjin, People's Republic of China
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