Interferon + BCG May Be an Alternative to Radical Cystectomy

Adding interferon to BCG may be a viable option for improving outcomes in patients with high-risk or recurrent non-muscle invasive bladder cancer (NMIBC) who are unable or unwilling to undergo radical cystectomy, according to researchers.

In a paper published online ahead of print in BJU International, a team at Auckland City Hospital in Auckland, New Zealand, led by Toni O'Regan, MD, noted that a combination of interferon alfa-2b and BCG works synergistically by increasing the immunologic effects of BCG at lower doses, thereby increasing its tolerability and ameliorating some of the adverse effects associated with its use. Using interferon alfa-2b with BCG is the current practice at their institution for NMIBC patients unable or unwilling to undergo radical cystectomy, the next management step recommended by guidelines.

The investigators analyzed the outcomes of the combination treatment in 45 NMIBC patients. The follow-up from the start of interferon alfa-2b and BCG treatment ranged from 1 month to 147 months, with a mean of 54.2 months and a median 44 months.

Of the 45 patients, 20 (56%) were disease free and 12 (27%) experienced disease recurrence at time the study was conducted, Dr. O'Regan's group reported. Another 10 patients (22%) had disease progression despite treatment, with 2 of them dying from their cancer.

In addition, the researchers found that the combination treatment was tolerable, with only 3 patients (7%) refusing ongoing treatment due to adverse events.

“The findings of this study showed that this therapy was pleasingly successful in our patient group,” the authors wrote.

The authors noted that their study does not establish, nor did it attempt to establish, whether adding interferon alfa-2b to BCG as a first-line therapy has increased efficacy compared with BCG alone.

The researchers noted that their study adds to a growing body of evidence suggesting that adding interferon alfa-2b to BCG “is a successful salvage option” for those unable or unwilling to undergo radical cystectomy. A study by Michael A. O'Donnell, MD, and colleagues found that 53% of patients started on the combination treatment after BCG alone had failed were disease free at 24 months, according to a report in The Journal of Urology (2001;166:1300-1305). In a study published in Urologic Oncology (2006;24:344-348), Fadi N. Joudi, MD, and colleagues showed that the combination resulted in a tumor-free rate of 45% in a BCG refractory group after a median follow up of 24 months.

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