Low-dose versus standard-dose bacille Calmette–Guérin for non-muscle-invasive bladder cancer: Systematic review and meta-analysis of randomized controlled trialsopen access
- Authors
- Choi, Se Young; Ha, Moon Soo; Kim, Jung Hoon; Chi, Byung Hoon; Kim, Jin Wook; Chang, In Ho; Kim, Tae-Hyoung; Myung, Soon Chul
- Issue Date
- Mar-2022
- Publisher
- 대한비뇨의학회
- Keywords
- Administration; intravesical; Adverse effects; Recurrence; Urinary bladder neoplasms
- Citation
- Investigative and Clinical Urology, v.63, no.2, pp 140 - 150
- Pages
- 11
- Journal Title
- Investigative and Clinical Urology
- Volume
- 63
- Number
- 2
- Start Page
- 140
- End Page
- 150
- URI
- https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/55802
- DOI
- 10.4111/icu.20210340
- ISSN
- 2466-0493
2466-054X
- Abstract
- Purpose: Intravesical BCG (bacille Calmette–Guérin) instillation in patients with non-muscle-invasive bladder cancer decreases the risk for tumor recurrence and progression. After one BCG product was discontinued, a chronic global BCG shortage occurred. We focused on identifying a reduced dose of BCG that could maintain efficacy and reduce adverse effects.Materials and Methods: We conducted a comprehensive literature search of PubMed, Embase, the Cochrane Library, CINAHL, Web of Science, and Scopus to identify randomized controlled trials through April 2021. The odds ratios (ORs) and 95% confidence intervals (CIs) for the low and standard doses in nine studies were compared. A low dose was defined as a low volume of BCG compared with the standard BCG dose (Armand Frappier, 120 mg; Connaught, 81 mg; Danish 1331, 120 mg; modified Danish 1331, 120 mg; Tokyo 172, 80 mg).Results: The low-dose group experienced aggravated recurrence (OR, 1.45; 95% CI, 1.09–1.94; p=0.01) but similar progression (OR, 1.11; 95% CI, 0.76–1.62; p=0.59), similar cancer-specific survival (OR, 1.02; 95% CI, 0.60–1.75; p=0.93), similar overall survival (OR, 1.09; 95% CI, 0.76–1.56; p=0.65), favorable adverse effects (OR, 0.41; 95% CI, 0.28–0.62; p<0.0001), and favorable withdrawal (OR, 0.42; 95% CI, 0.25–0.71; p=0.001).
Conclusions: Low-dose BCG had more unfavorable outcomes than did standard-dose BCG in terms of recurrence. Tumor progression, cancer-specific survival, and overall survival were similar between the doses. Low-dose BCG improved adverse effects and withdrawal. In the setting of BCG shortage, low-dose BCG may have strong potential as an alternative.
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