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Evidence summaries

Intravesical BCG and Antineoplastic Agents in Ta and T1 Bladder Cancer

In patients with medium/high risk Ta or T1 bladder cancer, immunotherapy with intravesical BCG following TUR and antineoplastic agents delay tumour recurrence. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 6 studies with a total of 585 subjects. There were significantly fewer patients with disease recurrence at 12 months in the BCG plus TUR (transurethral resection) group compared to TUR alone (OR 0.30, 95% CI 0.21 to 0.43). Adverse effects included cystitis (67%), haematuria (23%), fever (25%) and urinary frequency (71%).

A systematic review 2 including 11 studies with a total of 3703 subjects was abstracted in DARE.

Complete transurethral resection (TURB) alone was compared to TURB with adjuvant intravesical chemotherapy. The most commonly used drug was adriamycin, followed by mitomycin-C, thio-tepa, and cytosine arabinoside. Other drugs included epirubicin, peplomycin, neocarzinostat, and mitoxantrone. Duration of treatment ranged from a single instillation to protocols involving repeated instillation over 2 years. The use of intravesical chemotherapy had a major effect on reducing the bladder tumour recurrence rate at one year: OR 0.56 (95% CI 0.48 to 0.65, 11 studies). The effect was seen at 3 years as well: OR 0.50, (95% CI 0.40 to 0.62, 5 RCTs, 1371 patients).

    References

    • Shelley MD, Court JB, Kynaston H, Wilt TJ, Fish RG, Mason M. Intravesical Bacillus Calmette-Guerin in Ta and T1 Bladder Cancer. Cochrane Database Syst Rev 2000;(4):CD001986. [PubMed]
    • Huncharek M, Geschwind JF, Witherspoon B, McGarry R, Adcock D. Intravesical chemotherapy prophylaxis in primary superficial bladder cancer: a meta-analysis of 3703 patients from 11 randomized trials. J Clin Epidemiol 2000 Jul;53(7):676-80. [PubMed] [DARE]

Primary/Secondary Keywords