Efficacy of bacillus Calmette-Guérin Strains for Treatment of Nonmuscle Invasive Bladder Cancer: A Systematic Review and Network Meta-Analysis

Abstract

Bacillus Calmette-Guérin strains exhibited significant differences in efficacy compared to chemotherapy. However, no definitive conclusions could be reached regarding strain superiority, and head-to-head trials are greatly needed to further understand the importance of strain selection in determining bacillus Calmette-Guérin efficacy.

Are There Differences in Toxicity and Efficacy between Various Bacillus Calmette-Guerin Strains in Bladder Cancer Patients? Analysis of 844 Patients

“…In recent meta-analysis it was concluded, that BCG strains exhibit significant differences in efficacy compared to chemotherapy; however, no definitive conclusions could be reached regarding strain superiority [15,16]. Similar conclusions may be drawn from earlier meta-analysis conducted by the EORTC group [17].…”

Bacillus Calmette–Guérin strain differences as the basis for immunotherapies against bladder cancer

“…Interestingly, the effect of specific BCG strains could be modified by the use of maintenance therapy. 48 This analysis showed that the BCG strains exhibited significant differences in efficacy compared with chemotherapy. 47 Without maintenance, Connaught was more effective than TICE only for the time to first recurrence (hazard ratio 48, 95% CI 1.20-1.82, P < 0.001).…”

“…Boehm et al carried out a systematic review and network meta-analysis of trials evaluating BCG strains for the treatment of NMIBC against all possible comparators (different BCG strains, chemotherapy and non-BCG biological therapies) with intravesical chemotherapy as the common comparator ( Table 2). 48 This analysis showed that the BCG strains exhibited significant differences in efficacy compared with chemotherapy. However, in the network meta-analysis, no BCG strain showed significant superiority at preventing recurrence compared with any other strain.…”

“…44 However, 5-year progression-free survival was not significantly different between BCG Connaught (94.1%) and BCG TICE (87.9%; P = 0.3442). 45 Finally, in the Dutch Cooperative Trial evaluating mitomycin versus BCG TICE versus BCG RIVM in 469 patients with pTa/pT1 carcinoma 48 and carcinoma in situ of the urinary bladder after transurethral resection of bladder tumor, disease recurrence was observed in 43%, 64% and 46% of patients treated with mitomycin, BCG TICE and BCG RIVM, respectively. 45 Finally, in the Dutch Cooperative Trial evaluating mitomycin versus BCG TICE versus BCG RIVM in 469 patients with pTa/pT1 carcinoma 48 and carcinoma in situ of the urinary bladder after transurethral resection of bladder tumor, disease recurrence was observed in 43%, 64% and 46% of patients treated with mitomycin, BCG TICE and BCG RIVM, respectively.…”

“…Another small study reported no clinical difference between substrains (such as between BCG Glaxo and BCG Pasteur) in 99 patients with multiple recurrent pTa or pT1 bladder tumors. 45 Finally, in the Dutch Cooperative Trial evaluating mitomycin versus BCG TICE versus BCG RIVM in 469 patients with pTa/pT1 carcinoma 48 and carcinoma in situ of the urinary bladder after transurethral resection of bladder tumor, disease recurrence was observed in 43%, 64% and 46% of patients treated with mitomycin, BCG TICE and BCG RIVM, respectively. There were no significant differences between the two BCG substrains.…”