Instillation Strategies for Non-Muscle-Invasive Bladder Cancer in the Bacillus Calmette-Guerin Shortage Era: A Simple Solution for BCG Discontinuation

Po Ting Lin; Ming Li Hsieh; Shih Huan Su; Ying Hsu Chang; Liang Kang Huang; Yuan Cheng Chu; Hung Cheng Kan; Po Hung Lin; Kai Jie Yu; Cheng Keng Chuang; Chun Te Wu; See Tong Pang; I. Hung Shao

doi:10.2147/CMAR.S383627

Instillation Strategies for Non-Muscle-Invasive Bladder Cancer in the Bacillus Calmette-Guerin Shortage Era: A Simple Solution for BCG Discontinuation

Po Ting Lin, Ming Li Hsieh, Shih Huan Su, Ying Hsu Chang, Liang Kang Huang, Yuan Cheng Chu, Hung Cheng Kan, Po Hung Lin, Kai Jie Yu, Cheng Keng Chuang, Chun Te Wu, See Tong Pang, I. Hung Shao^*

^*此作品的通信作者

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研究成果: 期刊稿件 › 文章 › 同行評審

摘要

Objective: Among intravesical instillation protocol in patients with non-muscle-invasive bladder cancer (NMIBC), chemotherapy agents have been widely used during the bacillus Calmette-Guérin (BCG) shortage era since the patient might under the risk of BCG discontinuation. This study evaluates the efficacy of incomplete BCG instillation compared with pure chemotherapy instillation protocol. Materials and Methods: Patients newly diagnosed with intermediate-and high-risk NMIBC who received incomplete BCG intravesical instillation or chemotherapy instillation were retrospectively included. Patients were divided into three groups according to different intravesical instillation schedules: [BCG only], [BCG + Chemo], and [Chemo only]. Comparisons between these three groups were performed. Bladder recurrence-free survival (RFS) was analyzed as the primary endpoint. Results: A total of 475 patients who received intravesical instillations were enrolled. Compared to the [Chemo only] group, the [BCG + Chemo] group had significantly better bladder RFS (p = 0.027). Multivariate analysis of recurrence revealed the [BCG + Chemo] regimen has a hazard ratio 0.381 (95% CI 0.154–0.941, p = 0.037). The total instillation number >12 was associated with better RFS (p = 0.001) compared with other instillation numbers. Conclusion: For NMIBC patients facing the risk of unexpected BCG instillation interruption, instead of starting instillation with chemotherapy agents, receiving BCG first till stoppage then shifting to chemotherapy agents is recommended.

原文	英語
頁（從 - 到）	3121-3130
頁數	10
期刊	Cancer Management and Research
卷	14
DOIs	https://doi.org/10.2147/CMAR.S383627
出版狀態	已出版 - 2022

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© 2022 Lin et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).

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Lin, P. T., Hsieh, M. L., Su, S. H., Chang, Y. H., Huang, L. K., Chu, Y. C., Kan, H. C., Lin, P. H., Yu, K. J., Chuang, C. K., Wu, C. T., Pang, S. T., & Shao, I. H. (2022). Instillation Strategies for Non-Muscle-Invasive Bladder Cancer in the Bacillus Calmette-Guerin Shortage Era: A Simple Solution for BCG Discontinuation. Cancer Management and Research, 14, 3121-3130. https://doi.org/10.2147/CMAR.S383627

@article{1f7b9787e91f48ff970100b77b4e52a5,

title = "Instillation Strategies for Non-Muscle-Invasive Bladder Cancer in the Bacillus Calmette-Guerin Shortage Era: A Simple Solution for BCG Discontinuation",

abstract = "Objective: Among intravesical instillation protocol in patients with non-muscle-invasive bladder cancer (NMIBC), chemotherapy agents have been widely used during the bacillus Calmette-Gu{\'e}rin (BCG) shortage era since the patient might under the risk of BCG discontinuation. This study evaluates the efficacy of incomplete BCG instillation compared with pure chemotherapy instillation protocol. Materials and Methods: Patients newly diagnosed with intermediate-and high-risk NMIBC who received incomplete BCG intravesical instillation or chemotherapy instillation were retrospectively included. Patients were divided into three groups according to different intravesical instillation schedules: [BCG only], [BCG + Chemo], and [Chemo only]. Comparisons between these three groups were performed. Bladder recurrence-free survival (RFS) was analyzed as the primary endpoint. Results: A total of 475 patients who received intravesical instillations were enrolled. Compared to the [Chemo only] group, the [BCG + Chemo] group had significantly better bladder RFS (p = 0.027). Multivariate analysis of recurrence revealed the [BCG + Chemo] regimen has a hazard ratio 0.381 (95% CI 0.154–0.941, p = 0.037). The total instillation number >12 was associated with better RFS (p = 0.001) compared with other instillation numbers. Conclusion: For NMIBC patients facing the risk of unexpected BCG instillation interruption, instead of starting instillation with chemotherapy agents, receiving BCG first till stoppage then shifting to chemotherapy agents is recommended.",

keywords = "BCG, NMIBC, bladder cancer, bladder recurrence, intravesical chemotherapy, intravesical instillation",

author = "Lin, {Po Ting} and Hsieh, {Ming Li} and Su, {Shih Huan} and Chang, {Ying Hsu} and Huang, {Liang Kang} and Chu, {Yuan Cheng} and Kan, {Hung Cheng} and Lin, {Po Hung} and Yu, {Kai Jie} and Chuang, {Cheng Keng} and Wu, {Chun Te} and Pang, {See Tong} and Shao, {I. Hung}",

note = "Publisher Copyright: {\textcopyright} 2022 Lin et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).",

year = "2022",

doi = "10.2147/CMAR.S383627",

language = "英语",

volume = "14",

pages = "3121--3130",

journal = "Cancer Management and Research",

issn = "1179-1322",

publisher = "Dove Medical Press Ltd",

}

Lin, PT, Hsieh, ML, Su, SH, Chang, YH, Huang, LK, Chu, YC, Kan, HC, Lin, PH, Yu, KJ, Chuang, CK, Wu, CT, Pang, ST & Shao, IH 2022, 'Instillation Strategies for Non-Muscle-Invasive Bladder Cancer in the Bacillus Calmette-Guerin Shortage Era: A Simple Solution for BCG Discontinuation', Cancer Management and Research, 卷 14, 頁 3121-3130. https://doi.org/10.2147/CMAR.S383627

TY - JOUR

T1 - Instillation Strategies for Non-Muscle-Invasive Bladder Cancer in the Bacillus Calmette-Guerin Shortage Era

T2 - A Simple Solution for BCG Discontinuation

AU - Lin, Po Ting

AU - Hsieh, Ming Li

AU - Su, Shih Huan

AU - Chang, Ying Hsu

AU - Huang, Liang Kang

AU - Chu, Yuan Cheng

AU - Kan, Hung Cheng

AU - Lin, Po Hung

AU - Yu, Kai Jie

AU - Chuang, Cheng Keng

AU - Wu, Chun Te

AU - Pang, See Tong

AU - Shao, I. Hung

N1 - Publisher Copyright: © 2022 Lin et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).

PY - 2022

Y1 - 2022

N2 - Objective: Among intravesical instillation protocol in patients with non-muscle-invasive bladder cancer (NMIBC), chemotherapy agents have been widely used during the bacillus Calmette-Guérin (BCG) shortage era since the patient might under the risk of BCG discontinuation. This study evaluates the efficacy of incomplete BCG instillation compared with pure chemotherapy instillation protocol. Materials and Methods: Patients newly diagnosed with intermediate-and high-risk NMIBC who received incomplete BCG intravesical instillation or chemotherapy instillation were retrospectively included. Patients were divided into three groups according to different intravesical instillation schedules: [BCG only], [BCG + Chemo], and [Chemo only]. Comparisons between these three groups were performed. Bladder recurrence-free survival (RFS) was analyzed as the primary endpoint. Results: A total of 475 patients who received intravesical instillations were enrolled. Compared to the [Chemo only] group, the [BCG + Chemo] group had significantly better bladder RFS (p = 0.027). Multivariate analysis of recurrence revealed the [BCG + Chemo] regimen has a hazard ratio 0.381 (95% CI 0.154–0.941, p = 0.037). The total instillation number >12 was associated with better RFS (p = 0.001) compared with other instillation numbers. Conclusion: For NMIBC patients facing the risk of unexpected BCG instillation interruption, instead of starting instillation with chemotherapy agents, receiving BCG first till stoppage then shifting to chemotherapy agents is recommended.

AB - Objective: Among intravesical instillation protocol in patients with non-muscle-invasive bladder cancer (NMIBC), chemotherapy agents have been widely used during the bacillus Calmette-Guérin (BCG) shortage era since the patient might under the risk of BCG discontinuation. This study evaluates the efficacy of incomplete BCG instillation compared with pure chemotherapy instillation protocol. Materials and Methods: Patients newly diagnosed with intermediate-and high-risk NMIBC who received incomplete BCG intravesical instillation or chemotherapy instillation were retrospectively included. Patients were divided into three groups according to different intravesical instillation schedules: [BCG only], [BCG + Chemo], and [Chemo only]. Comparisons between these three groups were performed. Bladder recurrence-free survival (RFS) was analyzed as the primary endpoint. Results: A total of 475 patients who received intravesical instillations were enrolled. Compared to the [Chemo only] group, the [BCG + Chemo] group had significantly better bladder RFS (p = 0.027). Multivariate analysis of recurrence revealed the [BCG + Chemo] regimen has a hazard ratio 0.381 (95% CI 0.154–0.941, p = 0.037). The total instillation number >12 was associated with better RFS (p = 0.001) compared with other instillation numbers. Conclusion: For NMIBC patients facing the risk of unexpected BCG instillation interruption, instead of starting instillation with chemotherapy agents, receiving BCG first till stoppage then shifting to chemotherapy agents is recommended.

KW - BCG

KW - NMIBC

KW - bladder cancer

KW - bladder recurrence

KW - intravesical chemotherapy

KW - intravesical instillation

UR - http://www.scopus.com/inward/record.url?scp=85141356831&partnerID=8YFLogxK

U2 - 10.2147/CMAR.S383627

DO - 10.2147/CMAR.S383627

M3 - 文章

AN - SCOPUS:85141356831

SN - 1179-1322

VL - 14

SP - 3121

EP - 3130

JO - Cancer Management and Research

JF - Cancer Management and Research

ER -

Instillation Strategies for Non-Muscle-Invasive Bladder Cancer in the Bacillus Calmette-Guerin Shortage Era: A Simple Solution for BCG Discontinuation

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