Compared Efficacy of Adjuvant Intravesical BCG-TICE vs. BCG-RIVM for High-Risk Non-Muscle Invasive Bladder Cancer (NMIBC): A Propensity Score Matched Analysis

Abstract

Background: Intravesical immunotherapy with bacillus Calmette–Guerin (BCG) is the standard therapy for high-risk non-muscle invasive bladder cancer (NMIBC). The superiority of any BCG strain over another could not be demonstrated yet. Methods: Patients with NMIBCs underwent adjuvant induction ± maintenance schedule of intravesical immunotherapy with either BCG TICE or RIVM at two high-volume tertiary institutions. Only BCG-naïve patients and those treated with the same strain over the course of follow-up were included. One-to-one (1:1) propensity score matching (PSM) between the two cohorts was utilized to adjust for baseline demographic and tumor characteristics imbalances. Kaplan–Meier estimates and multivariable Cox regression models according to high-risk NMIBC prognostic factors were implemented to address survival differences between the strains. Sub-group analysis modeling of the influence of routine secondary resection (re-TUR) in the setting of the sole maintenance adjuvant schedule for the two strains was further performed. Results: 852 Ta-T1 NMIBCs (n = 719, 84.4% on TICE; n = 133, 15.6% on RIVM) with a median of 53 (24–77) months of follow-up were reviewed. After PSM, no differences at 5- years RFS, PFS, and CSS at both Kaplan–Meier and Cox regression analyses were detected for the whole cohort. In the sub-group setting of full adherence to European/American Urology Guidelines (EAU/NCCN), BCG TICE demonstrated longer 5-years RFS compared to RIVM (68% vs. 43%, p = 0.008; HR: 0.45 95% CI 0.25–0.81). Conclusion: When routinely performing re-TUR followed by a maintenance BCG schedule, TICE was superior to RIVM for RFS outcomes. However, no significant differences were detected for PFS and CSS, respectively.

Combined Modality Bladder-Sparing Therapy for Muscle-Invasive Bladder Cancer: How (Should) We Do It? A Narrative Review

“…Data from these studies emphasize that response rates to BCG therapy were similar to those seen in primary tumors [ 63 , 73 , 74 , 75 ]. Interestingly, although not yet studied in post-CMT patients, various BCG strains were found to perform differently in high-risk NMIBC, with several studies showing the superiority of the BCG-TICE strain over RIVM [ 76 , 77 ]. Despite adequate BCG exposure, Weiss et al reported that 33% of patients had further NMIBC recurrences and 19% progressed to MIBC, respectively [ 75 ].…”

A Systematic Review on the Role of Repeat Transurethral Resection after Initial en Bloc Resection for Non-Muscle Invasive Bladder Cancer

“…A recent study corroborated the important role of routine reTURB, followed by an adequate maintenance course of BCG in organ-sparing NMIBC patients [ 20 ]. Interestingly, reTURB was found to be associated with longer recurrence-free survival (RFS) in patients receiving TICE strain maintenance therapy than those using Connaught and RIVM [ 20 , 21 ]. However, it should be underlined that reTURB, which must be done on a patient who may still be suffering from the consequences of the last surgery, is an invasive and morbid technique that significantly lowers the patient quality of life.…”

“…Compared with initial TURB, reTURB can remove the residual tumors, detect understaging BC, improve the responsive rate of intravesical Bacillus Calmette-Guerin (BCG) instillation, and instruct further treatments [16][17][18][19]. A recent study corroborated the important role of routine reTURB, followed by an adequate maintenance course of BCG in organsparing NMIBC patients [20]. Interestingly, reTURB was found to be associated with longer recurrence-free survival (RFS) in patients receiving TICE strain maintenance therapy than those using Connaught and RIVM [20,21].…”

Relationship between Preoperative Pyuria and Bacille Calmette-Guerin Treatment in Intravesical Recurrence after Transurethral Resection of High-Risk, Non-Muscle Invasive, Bladder Carcinoma: A Retrospective Study of Human Data

“…A previous report showed that when routinely performing re-TUR followed by a maintenance BCG schedule, TICE was superior to RIVM for RFS outcomes. Further studies addressing the type of BCG may also be needed in the future [ 40 ].…”