Time Interval from Transurethral Resection of Bladder Tumor to BCG Induction Does Not Impact Therapeutic Response.

To investigate BCG tolerability and response with respect to timing of BCG administration following TUR in patients with non-muscle invasive bladder cancer (NMIBC).

A review of NMIBC patients at our institution managed with at least 'adequate BCG' (defined by the US FDA as at least 5/6 induction instillations with 2 additional instillations comprising either maintenance or repeat induction) at our institution from 2000-2018 was performed. Time from TUR to first instillation of induction BCG was stratified by quartile and analyzed as a continuous variable. Kaplan-Meier and log-rank tests analyzed differences in recurrence free- and progression-free survival (RFS, PFS). Cox proportional hazards regression models identified associations between risk factors and survival outcomes.

518 patients received adequate BCG at a median 26 days from TUR (range 6-188 days). 45 patients (9%) developed BCG intolerance at a median 12th instillation (range 7-33). When time from TUR to BCG was stratified into quartiles, there was no difference with respect BCG intolerance (P=0.966), RFS (P=0.632) nor PFS (P=0.789). On both univariate and multivariate regression analysis for RFS and PFS, time from TUR to BCG was not a significant predictor when analyzed by quartile nor as a continuous variable (HR for RFS 1.00, 95% CI 0.99-1.00, P=0.449 and for PFS 0.99, 95% CI 0.98-1.00, P=0.074).

The rates of tolerability and response to adequate BCG are not predicated on timing of induction BCG instillation after TUR. Early administration in properly selected patients is safe, and delays do not affect therapeutic response.

BJU international. 2021 Mar 30 [Epub ahead of print]

Patrick J Hensley, Kelly K Bree, Nathan Brooks, Justin Matulay, Roger Li, Graciela M Nogueras González, Neema Navai, H Barton Grossman, Colin P Dinney, Ashish M Kamat

Department of Urology, University of Texas MD Anderson Cancer Center, Houston., Department of Urology, Levine Cancer Institute, Atrium Health, Charlotte., Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa., Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston.