Increased Bacillus Calmette-Guérin Treatment Intensity Associated With Improved Outcomes in Elderly Patients With Non-Muscle-Invasive Bladder Cancer in US Clinical Practice.

To characterize Bacillus Calmette-Guérin (BCG) treatment patterns and associated outcomes in a large cohort of patients with non-muscle-invasive bladder cancer (NMIBC).

Our retrospective analysis of patients aged ≥ 66 years with stage 0-1 urothelial bladder carcinoma diagnosed between 2000 and 2012 in the US Surveillance, Epidemiology, and End Results (SEER)-Medicare database estimated proxies for recurrence and secondary events and both all-cause and bladder cancer-specific mortality. Proportional hazards models were used in conditional landmark analyses to compare adequate (≥ 5 induction instillations and ≥ 2 maintenance instillations) and inadequate BCG, stratified by National Comprehensive Cancer Network risk group.

Of 39,532 patients who met the selection criteria, 16,225 (41.0%) received BCG; of them, 4602 (28.4%; 11.6% overall) received adequate treatment. Adequately treated patients were slightly younger and healthier than inadequately treated patients. Half of patients with intermediate- and high-risk NMIBC did not receive BCG; few received adequate treatment. At the 12-month landmark, adequate BCG treatment was associated with decreased risks of recurrence and of cancer-specific and all-cause mortality in patients with intermediate- and high-risk disease.

We observed lower than expected use of adequate BCG treatment in patients with intermediate- to high-risk NMIBC despite evidence of improved outcomes, which suggested that practice patterns may not be in line with management recommendations in this population.

Urology. 2020 Jul 24 [Epub ahead of print]

Kyle A Richards, Shih-Wen Lin, Ching-Yi Chuo, Christina L Derleth, Jingbo Yi, Marko Zivkovic, Sarika Ogale, Sandip Prasad, G Joel Decastro, Gary D Steinberg

University of Wisconsin-Madison, Madison, WI, USA. Electronic address: ., Genentech, Inc., South San Francisco, CA, USA., Genesis Research, Hoboken, NJ, USA., Garden State Urology, Whippany, NJ, USA., Columbia University Medical Center, New York, NY, USA., New York University Langone Health, New York, NY, USA.