The challenges of Bacillus of Calmette-Guerin (BCG) therapy for high risk non muscle invasive bladder cancer treatment in older patients. Issue 5 (September 2018)

• Record Type: Journal Article
• Authors: Racioppi, Marco; Di Gianfrancesco, Luca; Ragonese, Mauro; Palermo, Giuseppe; Sacco, Emilio; Bassi, PierFrancesco
• Is Part Of: Journal of geriatric oncology. Volume 9:Issue 5(2018)
• Page Start: 507
• Page End: 512
• Publication Date: 2018-09
• Subjects: BC bladder cancer -- NMIBC non muscle invasive bladder cancer -- MIBC muscle invasive bladder cancer -- EAU European association of urology -- EORTC European Organisation for Research and Treatment of Cancer. -- TUR trans-urethral resection -- BCG Bacillus of Calmette-Guerin -- UTUC upper tract urothelial carcinoma -- NCCN National Comprehensive Cancer Network -- UICC Union International Contre le Cancer -- ASA American Society of Anesthesiology -- WHO PS World Health Organization Performance status -- GFR glomerular filtration rate -- CG Cockcroft–Gault -- BMI body mass index -- SIOG International Society of Geriatric Oncology -- CT computed tomography -- UTUC upper urinary tract cancer -- CTCAE Common terminology Criteria for Adverse Events v4.0 -- Cis carcinoma in Situ -- P p value -- CSM cancer-specific mortality -- CGA Complete Geriatric Assessment -- ADL activities of daily living -- IADL instrumental activities of daily living -- CISR-G Cumulative illness Rating Scale for Geriatrics; Elderly -- High grade non muscle invasive bladder cancer -- BCG -- Target therapy -- Complications -- Safety; Geriatric oncology -- Periodicals; Neoplasms -- Periodicals; Aged -- Periodicals; Geriatric oncology; Electronic journals; Periodicals; 618.976994005
• DOI: 10.1016/j.jgo.2018.03.020
• Languages: English
• ISSNs: 1879-4068

Abstract

Abstract: Objectives: To evaluate the efficacy and safety of a tailored endovesical immunotherapy protocol with biweekly BCG for elderly Patients with high risk non muscle invasive bladder cancer (HG-NMIBC). Materials and Methods: We retrospectively evaluated data from 200 patients older than 80 years newly diagnosed with HG-NMIBC: 100 (group 1) with multiple comorbidities (WHO PS 2–3, ASA score ≥3, Charlson Comorbidity index ≥3, GFR<60 mL/min) were treated with BCG induction course administered biweekly; 100 (group 2) with statistically significant better conditions were treated with standard weekly BCG therapy. After the induction treatment disease-free patients underwent to at least one year of BCG maintenance therapy. Endpoints were: initial response to BCG, cancer-free survival and rate of progression at 2 years, rate of complications. Results: No statistically significant differences were found in terms of initial response to BCG (69% in Group 1 vs 71% in Group 2, P = 0.75), cancer free survival (57% vs 55% respectively, P = 0.77) and rate of progression (20% vs 14% respectively, P = 0.26) at 2 years. The difference in the rate of overall complications was statistically significant (15% in Group 1 vs 27% in Group 2, P = 0.03), in the rate of severe complications was not statistically significant (5% in Group 1 vs 7% in Group 2, P = 0.61). Conclusion: A tailored regimen of BCG administration is possible and safe in frail elderly patients, limiting side effects and risk of undertreatment but maintaining oncological outcomes. Preliminary results in a small patients group are promising but larger randomized studies are needed to confirm our data.