Bacillus Calmette-Guérin (BCG) monotherapy is associated with better long-term efficacy than alternating therapy with mitomycin C (MMC) and BCG in patients with carcinoma in situ of the bladder, according to a new study.
The finding is from a study of 321 CIS patients from Finland, Norway, and Sweden enrolled in a prospective multicenter trial and randomized to receive either BCG monotherapy or alternating MMC/BCG therapy. After a median follow-up of 9.9 years (maximum 19.9 years) in the BCG monotherapy arm and 8.9 years (maximum 20.3 years) in the alternating treatment arm, investigators found that the risk of disease recurrence was significantly lower in the BCG monotherapy arm than the alternating treatment arm (49% vs. 59%) at 15 years). This difference in recurrence rates corresponded to a significant 26% decreased risk of recurrence, investigators led by Eero Kaasinen, MD, of Helsinki University Hospital in Helsinki, Finland, reported in the Scandinavian Journal of Urology(2016;50:360-368). The researchers observed no significant difference in progression risk and disease-specific and overall mortality between the groups.
Patients who experienced disease progression after 2 years compared with before 2 years had a significantly higher risk of dying from bladder carcinoma (77% vs. 35%), according to the researchers.
The study also showed that patients with primary CIS had a significant increased risk of recurrence compared with those who had comcomitant CIS.
In addition, Dr. Kaasinen's team found that patients in the MMC/BCG group were significantly less likely to terminate in the instillation regimen prematurely because of adverse effects. The probability of non-cessation of instillations at 6, 12, and 15 months for MMC/BCG vs BCG alone was 99% vs. 90%, 95% vs. 75%, and 94% vs. 73%, respectively.
Alternating therapy consisted of 6 weekly instillations of mitomycin C 40 mg followed by 10 instillations of BCG or MMC alternating monthly for 1 year. The same 6 + 10 schedule was followed for BCG monotherapy.
In an accompanying editorial, Kesavan Esuvaranathan, MD, of the National University of Singapore, wrote: “Kaasinen and colleagues are to be congratulated for contributing one of the best descriptions of the long-term, treatment-modified history of carcinoma in situ (CIS) of the bladder.”
Tumor location in patients with bladder adenocarcinoma (BAC) independently predicts survival outcomes, with tumors in the dome and urachus associated with better overall and disease-specific survival than those in the lateral wall and base, according to a new study.
A team led by Ramy F. Youssef, MD, of the University of California Irvine, retrospectively studied 1,361 BAC cases in which the tumor locations were known. They placed patients into 3 groups according to tumor location: dome and urachus (UD), lateral wall (LW), and base (trigone, ureteric orifices, and bladder neck [BL]).
The 5-year overall survival (OS) and disease-specific survival (DSS) rates were 37.3% and 49%, respectively, for all bladder cancer, Dr. Youssef and colleagues reported online ahead of print inUrologic Oncology. The 5-year OS rates were 42.3%, 35.9%, and 28.4% for UD, LW, and BL tumors, respectively. The 5-year DSS rates were 50.2%, 51.7%, and 42.1%, respectively.
In multivariable analysis controlling for tumor stage and grade, LW and BL tumors were associated with a 52% and 71% increased risk of death from any cause and a 30% and 57% increased risk of death from bladder cancer compared with UD tumors.
BAC is an uncommon variant of bladder cancer, accounting for about 0.5% to 2% of all bladder cancers in the United States, according to the investigators. Because of its rarity, the pathogenesis and natural history of BAC have not been well characterized, they noted.
The investigators stated that tumor location can stratify oncologic outcomes of patients with BAC independent of classic pathologic prognostics such as stage and grade. “Elucidation of prognostic factors, including tumor location, would aid in proper clinical decision making, permit informed patient counseling, and guide future directions in research,” the investigators wrote.
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