Clinical outcomes of chemotherapy with or without intravesical BCG in NMIBC patients: A Bayesian network meta-analysis.
Year: 2025
Type: conference-abstract
Abstract: e16599 Background: Non-muscle-invasive bladder cancer (NMIBC) is a recurrent urinary bladder malignancy traditionally treated with intravesical Bacillus Calmette–Guérin (BCG). Newer chemotherapeutics combined with BCG may enhance efficacy and safety, though clinical outcomes remain less-explored. We evaluated BCG monotherapy versus combination therapies through systematic review and network meta-analysis. Methods: A systematic literature search of 4 databases identified primary studies on chemotherapeutics with or without BCG in NMIBC. A Bayesian network meta-analysis was performed in R with pooled risk ratios (RR) with 95% credible intervals (CrI) using random or common effects models based on the Deviance Information Criterion (DIC), with quantification of surface under the cumulative ranking (SUCRA). Results: Our analysis included 19 studies (7,514 patients). For Complete Response (CR), Radiofrequency-Induced Thermo-chemotherapeutic Effect Mitomycin C (RITE-MMC) ranked highest (SUCRA: 91.22) but was less effective than BCG (RR: 0.52, CrI: 0.20–1.30). Chemohyperthermia (CHT), Sequential MMC+BCG and hyperthermic intravesical chemotherapy (HIVEC) showed comparable efficacy to BCG (RRs: 1.04, 1.05). HIVEC (RR: 0.11, CrI: 0.00–0.66, SUCRA: 87) and titanium glycerosolvate aquacomplex (TGA) (RR: 0.11, CrI: 0.00–0.76, SUCRA: 86.26) demonstrated superior efficacy in Progressive Disease (PD). For Recurrence Rate (RR), Neoadjuvant electromotive MMC (EMDA)+BCG ranked highest (SUCRA: 83.51, RR: 0.22, CrI: 0.02–2.19), followed by Sequential MMC+BCG (SUCRA: 65.82). Sequential MMC+BCG (SUCRA: 100, RR: 0.48, CrI: 0.35–0.67) significantly outperformed BCG (SUCRA: 62.77) in prolonging Recurrence-Free Survival (RFS). Conclusions: Our findings demonstrated Sequential MMC+BCG shows promise for improving recurrence-free survival and recurrence rates. HIVEC and intravesical gemcitabine demonstrated superior safety with fewer adverse events, offering valuable insights to optimize NMIBC treatment strategies. Outcome/Intervention (RR, CrI, SUCRA value) Neoadjuvant EMDA+BCG RITE Sequential MMC+BCG HIVEC BEXIDEM IV-Thiotepa BCG (SUCRA) Intravesical gemcitabine PD - - 0.51,0.30-0.85,55.65 0.11,0.00-0.66,87 - 1.03,0.62-1.72,17.22 17.95 0.49,0.13-1.53,53.64 RR 0.22,0.02-2.19,83.51 0.56,0.07-4.62,61.61 0.52,0.12-2.33,65.82 0.49,0.05-4.94,64.49 2.84,0.33-24.59,16.44 0.67,0.08-5.43,56.27 40.52 0.64,0.14-2.95,58.28 RFS - - 0.48,0.35-0.67,100 1.18,0.94-1.53,19.67 - - 62.77 NA Total Adverse Events - - 0.68,0.06-7.97,50.51 0.42,0.06-2.43,66.58 - 0.81,0.07-9.78,45.37 35.44 0.16,0.01-2.17,84.35 Hematuria 0.48,0.06-2.38,63.59 1.01,0.60-1.69,32.56 - 0.28,0.01-2.34,75.27 - 0.31,0.04-1.31,78.03 34.18 0.42,0.01-5.11,62.65 Dysuria - 0.85,0.14-4.93,39.37 - - 0.29,0.04-1.81,76.61 0.43,0.05-3.21,63.15 28.5 -
Source: Journal of Clinical Oncology
Authors: Arwa M. Ibrahim, Shree Rath, M. Rafiqul Islam, Victor Ghosh, Hurriyah Ramzan, Mohamed Mansour, Fatima Sajjad, Umama Alam, Madona Pakkam, Danisha Kumar, Rameez Qasim, Muzamil Khan, Nouman Aziz, Waseem Nabi
Institutions: University of Sharjah, All India Institute of Medical Sciences Bhubaneswar, Shaheed Suhrawardy Medical College, Andhra University, Dow University of Health Sciences, Zagazig University, Khyber Medical College, University of Medicine and Health Sciences, Allama Iqbal Medical College, George Washington University, Wyckoff Heights Medical Center
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4410816612