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Efficacy and toxicity in scheduled intravesical gemcitabine versus Bacille Calmette-Guérin for Ta and T1 bladder cancer: a systematic review and meta-analysis

BACKGROUND: We conducted a meta-analysis to compare the efficacy and toxicity of scheduled intravesical gemcitabine (GEM) and Bacille Calmette-Guérin (BCG) for Ta and T1 non-muscle invasive bladder cancer (NMIBC). METHODS: The database search was performed in Ovid Medline, Embase, Web of Science, Co...

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Autores principales: Lu, Jun-Lin, Xia, Qi-Dong, Liu, Chen-Qian, Sun, Jian-Xuan, Yang, Yuan-Yuan, Hu, Heng-Long, Wang, Shao-Gang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8797991/
https://www.ncbi.nlm.nih.gov/pubmed/35116595
http://dx.doi.org/10.21037/tcr-21-291
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author Lu, Jun-Lin
Xia, Qi-Dong
Liu, Chen-Qian
Sun, Jian-Xuan
Yang, Yuan-Yuan
Hu, Heng-Long
Wang, Shao-Gang
author_facet Lu, Jun-Lin
Xia, Qi-Dong
Liu, Chen-Qian
Sun, Jian-Xuan
Yang, Yuan-Yuan
Hu, Heng-Long
Wang, Shao-Gang
author_sort Lu, Jun-Lin
collection PubMed
description BACKGROUND: We conducted a meta-analysis to compare the efficacy and toxicity of scheduled intravesical gemcitabine (GEM) and Bacille Calmette-Guérin (BCG) for Ta and T1 non-muscle invasive bladder cancer (NMIBC). METHODS: The database search was performed in Ovid Medline, Embase, Web of Science, Cochrane Library from the commencement of the database to July 7, 2020. Trials using immediate instillation were excluded and we present the included studies in accordance with the PRISMA 2020 reporting checklist. The data extracted was analyzed using Stata 11.0 software. RESULTS: Six studies of 466 patients comparing GEM and BCG were finally included. No significant difference was detected between GEM and BCG group in recurrence free survival [hazard ratio (HR) =0.80, 95% confidence interval (95% CI), 0.46–1.37, P=0.410], progression free survival (HR =0.82, 95% CI, 0.38–1.77, P=0.621), and total adverse events [odds ratio (OR) =0.70, 95% CI, 0.38–1.29, P=0.253). However, patients receiving GEM treatment are less likely to develop urinary adverse events, such as dysuria (OR =0.50, 95% CI, 0.29–0.87) and hematuria (OR =0.40, 95% CI, 0.18–0.91). We performed subgroup analysis and found that the effects of GEM and BCG were similar even on patients with high recurrence risk tumor. Sensitivity analysis showed the robustness of the results. DISCUSSION: Scheduled intravesical GEM instillation has a similar effect with BCG instillation in preventing NMIBC recurrence and progression, but GEM therapy causes a lower incidence of dysuria and hematuria than BCG. GEM may be an alternative therapy for BCG. However, the results should be treated with caution due to the low to moderate quality of the included studies.
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spelling pubmed-87979912022-02-02 Efficacy and toxicity in scheduled intravesical gemcitabine versus Bacille Calmette-Guérin for Ta and T1 bladder cancer: a systematic review and meta-analysis Lu, Jun-Lin Xia, Qi-Dong Liu, Chen-Qian Sun, Jian-Xuan Yang, Yuan-Yuan Hu, Heng-Long Wang, Shao-Gang Transl Cancer Res Original Article BACKGROUND: We conducted a meta-analysis to compare the efficacy and toxicity of scheduled intravesical gemcitabine (GEM) and Bacille Calmette-Guérin (BCG) for Ta and T1 non-muscle invasive bladder cancer (NMIBC). METHODS: The database search was performed in Ovid Medline, Embase, Web of Science, Cochrane Library from the commencement of the database to July 7, 2020. Trials using immediate instillation were excluded and we present the included studies in accordance with the PRISMA 2020 reporting checklist. The data extracted was analyzed using Stata 11.0 software. RESULTS: Six studies of 466 patients comparing GEM and BCG were finally included. No significant difference was detected between GEM and BCG group in recurrence free survival [hazard ratio (HR) =0.80, 95% confidence interval (95% CI), 0.46–1.37, P=0.410], progression free survival (HR =0.82, 95% CI, 0.38–1.77, P=0.621), and total adverse events [odds ratio (OR) =0.70, 95% CI, 0.38–1.29, P=0.253). However, patients receiving GEM treatment are less likely to develop urinary adverse events, such as dysuria (OR =0.50, 95% CI, 0.29–0.87) and hematuria (OR =0.40, 95% CI, 0.18–0.91). We performed subgroup analysis and found that the effects of GEM and BCG were similar even on patients with high recurrence risk tumor. Sensitivity analysis showed the robustness of the results. DISCUSSION: Scheduled intravesical GEM instillation has a similar effect with BCG instillation in preventing NMIBC recurrence and progression, but GEM therapy causes a lower incidence of dysuria and hematuria than BCG. GEM may be an alternative therapy for BCG. However, the results should be treated with caution due to the low to moderate quality of the included studies. AME Publishing Company 2021-06 /pmc/articles/PMC8797991/ /pubmed/35116595 http://dx.doi.org/10.21037/tcr-21-291 Text en 2021 Translational Cancer Research. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
spellingShingle Original Article
Lu, Jun-Lin
Xia, Qi-Dong
Liu, Chen-Qian
Sun, Jian-Xuan
Yang, Yuan-Yuan
Hu, Heng-Long
Wang, Shao-Gang
Efficacy and toxicity in scheduled intravesical gemcitabine versus Bacille Calmette-Guérin for Ta and T1 bladder cancer: a systematic review and meta-analysis
title Efficacy and toxicity in scheduled intravesical gemcitabine versus Bacille Calmette-Guérin for Ta and T1 bladder cancer: a systematic review and meta-analysis
title_full Efficacy and toxicity in scheduled intravesical gemcitabine versus Bacille Calmette-Guérin for Ta and T1 bladder cancer: a systematic review and meta-analysis
title_fullStr Efficacy and toxicity in scheduled intravesical gemcitabine versus Bacille Calmette-Guérin for Ta and T1 bladder cancer: a systematic review and meta-analysis
title_full_unstemmed Efficacy and toxicity in scheduled intravesical gemcitabine versus Bacille Calmette-Guérin for Ta and T1 bladder cancer: a systematic review and meta-analysis
title_short Efficacy and toxicity in scheduled intravesical gemcitabine versus Bacille Calmette-Guérin for Ta and T1 bladder cancer: a systematic review and meta-analysis
title_sort efficacy and toxicity in scheduled intravesical gemcitabine versus bacille calmette-guérin for ta and t1 bladder cancer: a systematic review and meta-analysis
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8797991/
https://www.ncbi.nlm.nih.gov/pubmed/35116595
http://dx.doi.org/10.21037/tcr-21-291
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