Introduction:
While intravesical Bacillus Calmette-Guerin (BCG) is conventionally administered after a recovery interval following transurethral resection (TUR) to avoid complications related to absorption, there exist no guidelines on the appropriate interval after TUR to administer induction BCG. Herein, we investigate BCG tolerability and response with respect to timing following TUR in patients with non-muscle invasive bladder cancer (NMIBC).
Methods:
NMIBC patients managed with at least ‘adequate BCG’, defined by the US FDA as at least 5/6 induction instillations and two additional instillations as part of maintenance or repeat induction therapy, at our institution from 2000-2018 were included. Patients were stratified by time from TUR to first dose of induction BCG. Time to recurrence/progression were calculated from first BCG administration. Kaplan-Meier and log-rank tests analyzed differences in recurrence free- and progression-free survival (RFS, PFS).
Results:
512 patients (90%) received adequate BCG at a median 26 days from TUR. These patients were stratified into having received BCG < or ≥3 weeks after TUR (N=202 & 310 patients, respectively). The rate of BCG intolerance was similar between both groups (10.2% vs. 8.4%, P=0.507). There were no differences with regards to progression, recurrence or development of BCG unresponsive disease. RFS and PFS were also similar (median RFS 84 vs. 74 months, respectively, P=0.582; median PFS not reached, P=0.672). These results were consistent on ad hoc sensitivity analysis using various time-cutoff points from TUR to BCG instillation, including relation to the median time from TUR to BCG initiation as well as stratification by quartile.
Conclusion:
The rates of tolerability and response to adequate BCG are not predicated on timing of BCG instillation after TUR. Early administration in properly selected patients is safe, and delays do not affect therapeutic response. These data have implications during times of restricted healthcare access, including the COVID-19 pandemic.
Funding: The research was supported by the Wayne B. Duddlesten Professorship in Cancer Research, the Raymond and Maria Floyd Bladder Cancer Research Foundation Grant to AMK, and NIH/NCI UTMD Anderson SPORE in Genitourinary Cancer (Bladder) (P50CA091846) to CPND.
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Time Interval From Transurethral Resection to onset of BCG Induction Does Not Impact Therapeutic Response: Implications During Times of Impaired Access to Healthcare
Category
Bladder Cancer > Non-Muscle Invasive Bladder Cancer
Description
Poster #36
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Presented By: Patrick Hensley
Authors:
Patrick Hensley
Kelly Bree
Nathan Brooks
Justin Matulay
Roger Li
Graciela Nogueras González
Neema Navai
H Barton Grossman
Colin Dinney
Ashish M. Kamat