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 1st Faculty of Medicine Charles University and General University Hospital Prague Czechia

Department of Urology Comprehensive Cancer Center Medical University of Vienna Vienna Austria

Department of Urology Freeman Hospital Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne UK

Department of Urology General Teaching Hospital and 1st Faculty of Medicine Charles University in Praha Praha Czechia

Department of Urology Hopital Bichat Claude Bernard AP HP Université de Paris Cité Paris France

Department of Urology Pitié Salpêtrière Hospital AP HP GRC 5 Predictive Onco Urology Sorbonne University Paris France

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; Institute of Translational Medicine Lund University Malmö Sweden

Department of Urology UROSUD La Croix du Sud Hôpital Quint Fonsegrives France

Division of Urology Department of Surgical Sciences San Giovanni Battista Hospital University of Studies of Torino Turin Italy

Edinburgh Bladder Cancer Surgery Department of Urology Western General Hospital Edinburgh UK

Jefe Clínico Servicio de Urología Fundación Instituto Valenciano de Oncología Valencia Spain

Lancashire Teaching Hospitals NHS Foundation Trust Preston UK; University of Manchester Manchester UK

S H Ho Urology Centre Department of Surgery Faculty of Medicine Chinese University of Hong Kong Hong Kong China

S H Ho Urology Centre Department of Surgery Faculty of Medicine Chinese University of Hong Kong Hong Kong China; Li Ka Shing Institute of Health Sciences Chinese University of Hong Kong Hong Kong China; Department of Urology Medical University of Vienna Austria Vienna

Surgical Oncology Netherlands Cancer Institute The Netherlands

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