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Evidence summaries

Intravesical Bacillus Calmette-Guerin Versus Mitomycin C for Bladder Cancer.

Intravesical bacillus Calmette-Guérin (BCG) and mitomycin C (MMC) appear to be equivocal in terms of disease progression and survival in medium to high risk bladder cancer patients combined, but the tumour recurrence is reduced with BCG compared to MMC in high risk patients. There are insufficient data on disease progression and survival in high-risk patients. Level of evidence: "B"

A Cochrane review [Abstract] 1 [withdrawn from publication] included 7 studies with a total of 1 901 subjects. The trials included included medium to high risk patients with Ta or T1 bladder cancer. Six trials had sufficient data for meta-analysis and included 1 527 patients, 693 in the mitomycin arm and 834 in the BCG arm. There was no significant difference for tumour recurrence between MMC and BCG (P = 0.76). A subgroup analysis of three trials that included only high risk Ta and T1 patients was in favour of BCG (P = 0.0008). Only two trials included sufficient data to analyse disease progression and survival, representing a total of 681 patients; 338 randomised to BCG and 343 to MMC. There was no significant difference between MMC and BCG for disease progression (log hazard ratio + variance: 0.044 + 0.04, P = 0.16) or survival (-0.112 + 0.03, P = 0.50). Local toxicities (dysuria, cystitis, frequency, and haematuria) were associated with both MMC (30%) and BCG (44%). Systemic toxicities, such as chills, fever and malaise, were observed with both MMC and BCG (12% and 19%, respectively) although skin rash was more common with MMC.

Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes).

    References

    • Shelley M, Court JB, Kynaston HG et al. WITHDRAWN: Intravesical Bacillus Calmette-Guérin versus mitomycin C for Ta and T I bladder cancer. Cochrane Database Syst Rev 2015;(11):CD003231. [PubMed]

Primary/Secondary Keywords