Abstract
This systematic review and cumulative analysis aimed to explore the efficacy and safety of the combination of intravesical mitomycin C (MMC) plus bacillus Calmette-Guerin (BCG) for non-muscle-invasive bladder cancer (NMIBC) patients. A comprehensive literature search using Pubmed, Embase, Medline, Cochrane Library, CBM, CNKI and VIP databases was performed to identify studies applying intravesical MMC plus BCG therapy on NMIBC patients up to June 2016. Summarized unadjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to assess the efficacy and safety of the combination therapy. A total of 25 studies containing 2749 NMIBC patients were included in this systematic review. Compared with BCG monotherapy, the combination therapy could significantly reduce the tumor recurrence rate (OR = 0.64, 95% CI: 0.44–0.94, P = 0.02) and cancer-specific mortality (OR = 0.54, 95% CI: 0.34–0.87, P = 0.01), without more toxicities (OR = 0.58, 95% CI: 0.17–1.94, P = 0.37). The combination therapy could also lead to significant lower tumor recurrence rate than MMC monotherapy (OR = 0.41, 95% CI: 0.24–0.69, P = 0.0009). Our study indicates that the combination of MMC plus BCG instillation is an effective and safe adjuvant treatment for NMIBC patients.
Highlights
Most widely used adjuvant agents are bacillus Calmette-Guerin (BCG) and mitomycin C (MMC), especially for tumors with intermediate to high recurrence or progression rate[5]
MMC + BCG versus BCG alone was conducted in 10 studies[10, 11, 13, 14, 16,17,18, 24, 27, 29], MMC + BCG versus MMC alone was referred in 7 studies[12, 15, 19, 28, 31, 33, 34] and the rest 126 compared MMC + BCG with either MMC or BCG
In 3 studies, we reported multivariable adjusted hazard ratios (HRs) to prevent tumor recurrence of combined MMC and BCG instillation compared with BCG alone
Summary
Most widely used adjuvant agents are bacillus Calmette-Guerin (BCG) and mitomycin C (MMC), especially for tumors with intermediate to high recurrence or progression rate[5]. Intravesical BCG is the most recommended treatment for non-muscle-invasive bladder cancer (NMIBC) with a relative satisfactory effect according to EAU guidelines[6]. Combination of intravesical MMC plus BCG instillation, a novel adjuvant therapy, has been researched in a variety of studies and showed a more enhanced antitumor effect[8, 9]. No guidelines or protocols have been made yet to recommend the combination of intravesical MMC and BCG therapy for NMIBC. As far as we have concerned, few conclusive articles or reviews focused on the efficacy and safety of various intravesical MMC plus BCG therapies on NMIBC patients.
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