Role of oral pentosan polysulfate in Bacillus Calmette–Guérin therapy in patients with non-muscle-invasive bladder cancer

Abstract

Purpose Intravesical Bacillus Calmette–Guérin (BCG) instillation, although an important treatment for non-muscle-invasive bladder cancer, exerts local and systemic adverse effects. Pentosan polysulfate (PPS) is a bladder mucosal protective drug that acts by replacing mucus in the glycosaminoglycan layer of the damaged urothelium. We hypothesized that co-administration of oral PPS with BCG instillation would relieve BCG-related adverse effects without affecting its efficacy. Materials and Methods A total of 217 patients receiving BCG instillation were enrolled. They were placed in two groups and analyzed retrospectively: group A (n=122) received BCG instillation only and group B (n=95) received 100 mg of PPS thrice daily during the BCG treatment. Results After BCG instillation, the rate of BCG-treatment discontinuation owing to adverse effects was 15.6% in group A and 6.3% in group B (p=0.034). The proportion of patients with bacteriuria after BCG was higher in group B; however, no statistical difference was observed (28.7% vs. 41.1%; p=0.057). The proportion of patients with pyuria was significantly higher in group B (81.1% vs. 91.6%; p=0.029). The proportion of patients using antibiotics was significantly higher in group A (73.8% vs. 43.2%; p=0.001). The recurrence rate within 1 year was 29 (23.8%) in group A vs. 19 (20.0%) in group B (p=0.507). Univariate and multivariate analyses showed that antibiotic use had a statistically significant effect on BCG discontinuation. Conclusions Oral PPS effectively decreased the discontinuation rate and antibiotic use without affecting the BCG efficacy.

BCG induced lower urinary tract symptoms during treatment for NMIBC—Mechanisms and management strategies

“…Treatments that have been used successfully to treat IC/BPS symptoms, including pentosane polysulfate (PPS), via restoration of urothelial permeability have been proposed as promising treatments for preventing BCG induced LUTS. In a clinical cohort of 217 patients receiving BCG instillations for NMIBC, co-administration of oral PPS thrice daily effectively decreased the BCG discontinuation rate compared to placebo (15.6% vs. 6.3%) without impacting BCG efficacy (Lee et al, 2022 ). A separate small study showed oral PPS was effective in reducing BCG induced LUTS with a reduction in the post-treatment Visual Analog Scale (VAS) score for pain, the post-treatment OAB-V8 score, and dysuria (Yadav et al, 2016 ).…”