MP73-05 BCG-UNRESPONSIVE NMIBC, COMPARISON OF 2 ND -LINE INTRAVESICAL INSTILLATION THERAPY

Abstract

You have accessJournal of UrologyBladder Cancer: Non-invasive IV (MP73)1 Apr 2020MP73-05 BCG-UNRESPONSIVE NMIBC, COMPARISON OF 2ND-LINE INTRAVESICAL INSTILLATION THERAPY Gal Rinott Mizrahi*, Yuval Freifeld, Ido Orlin, Ilona Pilosov, Boris Friedman, and Yoram Dekel Gal Rinott Mizrahi*Gal Rinott Mizrahi* More articles by this author , Yuval FreifeldYuval Freifeld More articles by this author , Ido OrlinIdo Orlin More articles by this author , Ilona PilosovIlona Pilosov More articles by this author , Boris FriedmanBoris Friedman More articles by this author , and Yoram DekelYoram Dekel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000959.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Intravesical instillation of live attenuated bacillus Calmette-Guérin (BCG) is the gold standard treatment for intermediate and high-risk Non-Muscle-Invasive Bladder Cancer (NMIBC), with proven effects on reducing recurrence, progression, and death. However, it is not effective in all patients, and recurrence after adequate BCG therapy can lead to progression and to a life-threatening disease. For this reason, the current recommendation for BCG-unresponsive disease is early radical cystectomy. In practice, most patients at that point prefer less aggressive treatment or are un-fit for radical surgery and therefore are treated with 2nd-line intravesical instillations. The objective of the current study is to compare 2nd line treatments for BCG-unresponsive disease. METHODS: This is a retrospective study based on a single institutional database. The study population included patients with BCG-unresponsive disease treated in our department during 2008-2016. BCG-unresponsive disease was defined as persistence or progression within 12 months of adequate BCG therapy. For each patient data regarding 2nd line therapy and oncologic outcome was obtained. RESULTS: Of 315 patients treated with BCG during the defined period, 68 patients had BCG-unresponsive disease. Presentation of unresponsive disease was with muscle invasive/metastatic disease in 25% of patients and with NMIBC in 75% of patients (n=51). In the NMIBC group 6 patients had early cystectomy, 21 were treated with re-induction BCG and 23 were treated with Thermo-chemotherapy Mitomycin C (SYNERGO). Response to 2nd line treatment was observed in 33.3% and 39.1% in the BCG and SYNERGO groups respectively. Immediate progression to muscle invasive/metastatic disease was observed in 19% and 26.1% in the BCG and SYNERGO groups respectively. In each group 3 patients further progressed to metastatic disease during follow-up. CONCLUSIONS: We found a response rate to 2nd line intravesical instillation therapy in BCG-unresponsive disease of 35% with no significant difference between re-induction with BCG or SYNERGO. Progression to muscle invasive/metastatic disease was observed in 35% of patients with no significant difference between groups. These results emphasize the need to present to patients with BCG-unresponsive disease, the poor prognosis of their disease and encourage strongly towards early cystectomy. For patient who refuse or are un-fit, there is no significant differences between re-induction with BCG or SYNERGO. Source of Funding: non © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1122-e1123 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gal Rinott Mizrahi* More articles by this author Yuval Freifeld More articles by this author Ido Orlin More articles by this author Ilona Pilosov More articles by this author Boris Friedman More articles by this author Yoram Dekel More articles by this author Expand All Advertisement PDF downloadLoading ...