Long‐term outcomes of bladder‐sparing therapy vs radical cystectomy in BCG‐unresponsive non‐muscle‐invasive bladder cancer

Author:

Taylor Jacob I.1ORCID,Kamat Ashish M.2,O'Donnell Michael A.3ORCID,Annapureddy Drupad1,Howard Jeffrey1ORCID,Tan Wei Shen2,McElree Ian3ORCID,Davaro Facundo4,Yim Kendrick5,Harrington Stephen6,Dyer Elizabeth6,Black Anna J.7,Kanabur Pratik8,Roumiguié Mathieu9ORCID,Lerner Seth8,Black Peter C.7,Raman Jay D.6,Preston Mark A.5,Steinberg Gary10,Huang William10,Li Roger4ORCID,Packiam Vignesh T.3,Woldu Solomon L1,Lotan Yair1ORCID

Affiliation:

1. University of Texas Southwestern Medical Center Dallas TX USA

2. University of Texas MD Anderson Cancer Center Houston TX USA

3. University of Iowa Iowa City IA USA

4. Moffit Cancer Center Tampa FL USA

5. Brigham and Women's Hospital Boston MA USA

6. Penn State Health Hershey PA USA

7. University of British Columbia Vancouver British Columbia Canada

8. Baylor College of Medicine Houston TX USA

9. CHU‐Institut Universitaire du Cancer‐Oncopôle Toulouse France

10. New York University Langone Health New York NY USA

Abstract

ObjectiveTo quantify the oncological risks of bladder‐sparing therapy (BST) in patients with Bacillus Calmette–Guérin (BCG)‐unresponsive non‐muscle‐invasive bladder cancer (NMIBC) compared to upfront radical cystectomy (RC).Patients and MethodsPre‐specified data elements were collected from retrospective cohorts of patients with BCG‐unresponsive NMIBC from 10 international sites. After Institutional Review Board approval, patients were included if they had BCG‐unresponsive NMIBC meeting United States Food and Drug Administration criteria. Oncological outcomes were collected following upfront RC or BST. BST regimens included re‐resection or surveillance only, repeat BCG, intravesical chemotherapy, systemic immunotherapy, and clinical trials.ResultsAmong 578 patients, 28% underwent upfront RC and 72% received BST. The median (interquartile range) follow‐up was 50 (20–69) months. There were no statistically significant differences in metastasis‐free survival, cancer‐specific survival, or overall survival between treatment groups. In the BST group, high‐grade recurrence rates were 37% and 52% at 12 and 24 months and progression to MIBC was observed in 7% and 13% at 12 and 24 months, respectively. RC was performed in 31.7% in the BST group and nodal disease was found in 13% compared with 4% in upfront RC (P = 0.030).ConclusionIn a selected cohort of patients, initial BST offers comparable survival outcomes to upfront RC in the intermediate term. Rates of recurrence and progression increase over time especially in patients treated with additional lines of BST.

Publisher

Wiley

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