Replacement Instead of Discontinuation of Bacillus Calmette-Guérin Instillation in Non-Muscle-Invasive Bladder Cancer

SIMPLE SUMMARY: Most patients with intermediate- and high-risk non-muscle-invasive bladder cancer (NMIBC) fail to complete bacillus Calmette-Guérin (BCG) instillation due to toxicity or shortage. Our retrospective study aimed to assess the efficacy of intravesical chemotherapy replacement at the time of BCG interruption. We confirmed the chemotherapy replacement group had a better three-year bladder recurrence-free survival (RFS) than the BCG discontinuation group. Chemotherapy replacement is then a helpful strategy in patients with NMIBC facing BCG treatment stoppage. ABSTRACT: Background: To evaluate the efficacy of intravesical chemotherapy replacement in patients with intermediate- and high-risk non-muscle-invasive bladder cancer (NMIBC), who underwent bacillus Calmette-Guérin (BCG) instillation but discontinued due to global shortages or toxicity of BCG. Methods: This retrospective study included patients with intermediate- and high-risk NMIBC who received BCG intravesical instillation. Those who discontinued the treatment were divided into the pure BCG group and chemotherapy replacement group. Comparisons between these groups were performed. The primary endpoint was bladder recurrence-free survival (RFS). Results: A total of 480 patients were included. Baseline characteristics were similar between groups, but the total instillation times were higher in the chemotherapy replacement group than in the pure BCG group (n = 14.9 vs. 10.5). The chemotherapy replacement group had a better three-year RFS (p = 0.022). On multivariate analysis, the pure BCG group had significantly increased all-time and 3-year recurrences (hazard ratio 2.015 and 2.148) compared to the chemotherapy replacement group. Conclusions: Chemotherapy replacement has a better three-year RFS than no instillation in patients with intermediate- and high-risk NMIBC who received BCG instillation but facing treatment stoppage.