Is CIS a Contraindication to Hyperthermic Intravesical Chemotherapy (HIVEC) after BCG-Failure?

CIS of the bladder is associated with a high risk of progression. In the case of BCG failure, radical cystectomy should be performed. For patients who refuse or are ineligible, bladder-sparing alternatives are evaluated. This study aims to investigate the efficacy of Hyperthermic IntraVesical Chemotherapy (HIVEC) depending on the presence or absence of CIS. This retrospective, multicenter study was conducted between 2016 and 2021. Patients with non-muscle-invasive bladder cancer (NMIBC) with BCG failure received 6-8 adjuvant instillations of HIVEC. The co-primary endpoints were recurrence-free survival (RFS) and progression-free survival (PFS). A total of 116 consecutive patients met our inclusion criteria of whom 36 had concomitant CIS. The 2-year RFS rate was 19.9% and 43.7% in patients with and without CIS, respectively (p = 0.52). Fifteen patients (12.9%) experienced progression to muscle-invasive bladder cancer with no significant difference between patients with and without CIS (2-year PFS rate = 71.8% vs. 88.8%, p = 0.32). In multivariate analysis, CIS was not a significant prognostic factor in terms of recurrence or progression. In conclusion, CIS may not be considered a contraindication to HIVEC, as there is no significant association between CIS and the risk of progression or recurrence after treatment.

Cancers. 2023 Feb 24*** epublish ***

Vassili Anastay, Michael Baboudjian, Alexandra Masson-Lecomte, Cédric Lebacle, Alexandre Chamouni, Jacques Irani, Xavier Tillou, Thibaut Waeckel, Arnaud Monges, Céline Duperron, Gwenaelle Gravis, Jochen Walz, Eric Lechevallier, Géraldine Pignot

Department of Urology, La Conception Hospital, Aix-Marseille University, Assistance Publique des Hôpitaux de Marseille (APHM), 13007 Marseille, France., Department of Urology, University de Paris, APHP, Saint Louis Hospital, 75010 Paris, France., Department of Urology, Kremlin-Bicêtre Academic Hospital, 94270 Bicêtre, France., Department of Urology, Centre Hospitalier Universitaire Caen, 14033 Caen, France., Department of Urology, Polyclinique du Parc Rambot, Hôpital Privé de Provence, 13080 Aix-en-Provence, France., Department of Urology, University Hospital François Mitterrand, 21000 Dijon, France., Department of Medical Oncology, Institut Paoli Calmettes Cancer Center, 13009 Marseille, France., Department of Surgical Oncology 2, Institut Paoli-Calmettes Cancer Center, 13009 Marseille, France.