Intravesical Chemohyperthermia vs. Bacillus Calmette-Guerin Instillation for Intermediate- and High-Risk Non-muscle Invasive Bladder Cancer: A Systematic Review and Meta-Analysis

Hongda Zhao, Vinson Wai-Shun Chan, Daniele Castellani, Erica On-Ting Chan, William Lay Keat Ong, Qiang Peng, Marco Moschini, Wojciech Krajewski, Benjamin Pradere, Chi-Fai Ng, Dmitry Enikeev, Nikhil Vasdev, Gokhan Ekin, Alejandro Sousa, Juan Leon, Felix Guerrero-Ramos, Wei-Shen Tan, John Kelly, Shahrokh F. Shariat, J. Alfred WitjesJeremy Yuen-Chun Teoh

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Abstract

Background: The efficacy of intravesical chemotherapy maintenance for patients with non-muscle invasive bladder cancer (NMIBC) is inferior compared to intravesical bacillus Calmette–Guerin (BCG). How intravesical chemohyperthermia (CHT) compares with BCG is under investigation.

Objective: To compare the oncological outcomes and safety profile between intravesical CHT and BCG treatment for intermediate- and high-risk NMIBC. Methods: We performed a systematic review and meta-analysis of clinical studies comparing CHT with BCG for intermediate- and high-risk NMIBC patients. A comprehensive literature search on OVID MEDLINE, EMBASE, and Cochrane Library was conducted. Risk of bias was assessed by the Cochrane RoB tool and ROBINS-I. Certainty of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.

Results: A total of 2,375 articles were identified and five studies were finally included. Among them, four randomised trials comprising 327 patients (CHT group: 156 patients; BCG group: 171 patients) were included in the meta-analysis. There were no significant differences in the 24–36 months recurrence rates (CHT: 29.5%, BCG: 37.4%; RR: 0.83, 95% CI 0.61–1.13; moderate certainty of evidence) and the 24–36 months progression rates (CHT: 4.4%, BCG: 7.6%, RR = 0.62, 95% CI 0.26–1.49; low certainty of evidence). There were also no significant differences in grade 1–2 adverse events (CHT group: 59.9%, BCG group 54.5%; RR = 1.10, 95% CI 0.93–1.30; moderate certainty of evidence) and grade 3 or above adverse events (CHT group: 23.2%, BCG group 22.5%; RR = 0.99, 95% CI 0.69–1.43; low certainty of evidence).

Conclusions: Intravesical CHT had equivalent oncological outcomes and similar safety profile when compared to BCG maintenance therapy for patients with intermediate- and high-risk NMIBC. CHT is a possible alternative treatment in the times of BCG shortage.
Original languageEnglish
Article number775527
Number of pages12
JournalFrontiers in Surgery
Volume8
Early online date23 Nov 2021
DOIs
Publication statusE-pub ahead of print - 23 Nov 2021

Keywords

  • Surgery
  • bladder cancer
  • TURBT (trans-urethral resection of bladder tumour)
  • BCG–Bacillus Calmette-Guérin vaccine
  • chemohyperthermia
  • meta-analysis

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