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A Systematic Review and Meta-analysis of the Clinical Impact of Prophylactic Quinolones with Adjuvant Bacillus Calmette-Guérin Instillation for Non-muscle-invasive Bladder Cancer
CH. Wong, IC. Ko, DK. Leung, SK. Yuen, B. Siu, Y. Yuan, A. Birtle, O. Capoun, E. Compérat, JL. Domínguez-Escrig, F. Liedberg, P. Mariappan, M. Moschini, B. Pradere, BP. Rai, BWG. van Rhijn, T. Seisen, SF. Shariat, F. Soria, V. Soukup, EN....
Language English Country Netherlands
Document type Journal Article, Systematic Review, Meta-Analysis, Review
- MeSH
- Adjuvants, Immunologic * therapeutic use administration & dosage MeSH
- Chemotherapy, Adjuvant MeSH
- Administration, Intravesical MeSH
- BCG Vaccine * therapeutic use administration & dosage MeSH
- Quinolones * therapeutic use administration & dosage MeSH
- Neoplasm Invasiveness * MeSH
- Humans MeSH
- Non-Muscle Invasive Bladder Neoplasms MeSH
- Urinary Bladder Neoplasms * drug therapy pathology MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Meta-Analysis MeSH
- Review MeSH
- Systematic Review MeSH
BACKGROUND AND OBJECTIVE: Bacillus Calmette-Guérin (BCG) reduces disease recurrence and progression in intermediate- and high-risk non-muscle-invasive bladder cancer (NMIBC). BCG-associated adverse events during instillations are common, leading to treatment cessation. Prophylactic use of quinolones in conjunction with BCG instillations is one approach for reducing BCG-associated adverse events. Our aim was to delineate the clinical impact of quinolone prophylaxis (QP) in patients receiving adjuvant BCG instillations for NMIBC. METHODS: In October 2024, a systematic search of MEDLINE, Embase, and the Cochrane Central Register of controlled trials was performed. Prospective and retrospective studies reporting comparative outcomes for patients with and without QP during BCG instillations were included. Outcomes were reported in a binary fashion. Random-effects meta-analysis using the weighted mean difference was conducted. Primary outcomes for pooled analyses included BCG-associated toxicities, the completion rate for BCG induction, the likelihood of antituberculosis treatment, and disease recurrence and progression at 12 mo. KEY FINDINGS AND LIMITATIONS: The systematic review included five studies. Four randomised controlled trials were included in the meta-analysis, and one nonrandomised study was also included in the narrative review. The studies involved 445 patients, of whom 194 received QP + BCG and 251 received BCG alone. QP use was associated with lower incidence of class ≥2 (40.8% vs 54.7%; relative risk [RR] 0.79, 95% confidence interval [CI] 0.67-0.94; p = 0.006), and class ≥3 BCG-associated toxicities (25.3% vs 36.4%; RR 0.70, 95% CI 0.50-0.98; p = 0.04) and a higher completion rate for BCG induction (83.0% vs 70.6%; RR 1.16, 95% CI 1.01-1.34; p = 0.04). The 12-mo recurrence rates (14.7% vs 19.4%; RR 0.76, 95% CI 0.46-1.27; p = 0.3) and progression rates (4.5% vs 6.4%; RR 0.86, 95% CI 0.09-8.25; p = 0.9) did not significantly differ for QP + BCG versus BCG alone. CONCLUSIONS AND CLINICAL IMPLICATIONS: The use of QP with adjuvant BCG for NMIBC mitigated debilitating BCG-associated toxicities and improved the completion rate for BCG induction therapy.
Department of Medicine London Health Science Centre London Canada
Department of Medicine McMaster University Health Science Centre Hamilton Canada
Department of Pathology Medical University of Vienna Vienna Austria
Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria
Department of Urology Hopital Bichat Claude Bernard AP HP Université de Paris Cité Paris France
Department of Urology Medical University of Vienna Austria Vienna
Department of Urology Saint Louis Hospital AP HP Université de Paris Paris France
Department of Urology San Raffaele Hospital Milan Italy
Department of Urology Skåne University Hospital Malmö Sweden
Department of Urology UROSUD La Croix du Sud Hôpital Quint Fonsegrives France
Edinburgh Bladder Cancer Surgery Department of Urology Western General Hospital Edinburgh UK
Institute of Translational Medicine Lund University Malmö Sweden
Jefe Clínico Servicio de Urología Fundación Instituto Valenciano de Oncología Valencia Spain
Lancashire Teaching Hospitals NHS Foundation Trust Preston UK
Li Ka Shing Institute of Health Sciences Chinese University of Hong Kong Hong Kong China
Surgical Oncology Netherlands Cancer Institute The Netherlands
References provided by Crossref.org
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