Ketty Bai, Srinath-Reddi Pingle, Rainjade Chung, Benjamin I Joffe, Caroline Laplaca, G Joel Decastro, James M McKiernan, Christopher B Anderson, Andrew T Lenis
{"title":"重新审视卡介苗：卡介苗抢救治疗对卡介苗无反应的非肌肉浸润性膀胱癌的潜力。","authors":"Ketty Bai, Srinath-Reddi Pingle, Rainjade Chung, Benjamin I Joffe, Caroline Laplaca, G Joel Decastro, James M McKiernan, Christopher B Anderson, Andrew T Lenis","doi":"10.1016/j.urolonc.2025.08.007","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the role of Rescue BCG in the treatment of BCG-unresponsive nonmuscle-invasive bladder cancer (NMIBC), in order to inform clinical decision-making especially when access to alternative therapies is limited.</p><p><strong>Methods: </strong>From an institutional database, patients who met the criteria of BCG-unresponsive NMIBC between 2002 and 2023 were identified and sorted into 2 cohorts: those who received additional BCG therapy immediately after BCG-unresponsive designation and those who received alternative treatments such as intravesical chemotherapy and radical cystectomy. Primary endpoint was progression-free survival (PFS). Secondary endpoints included high-grade (HG) recurrence-free survival (RFS) and overall survival (OS).</p><p><strong>Results: </strong>A total of 120 patients with BCG-unresponsive NMIBC were evaluated. Of these, 66 received Rescue BCG, and 54 did not. Both cohorts were similar in demographics, although the Rescue BCG cohort had significantly more HG T1 disease. The 1-year PFS for Rescue BCG was 95.3% compared with 84.5% for No Rescue BCG (log rank, P = 0.4). Multivariable analyses showed Rescue BCG significantly reduced disease progression (HR: 0.38, 95% CI, 0.14-0.99) and improved overall survival (HR: 0.18, 95% CI, 0.04-0.79), though no difference in HG recurrence was found. Limitations include retrospective design.</p><p><strong>Conclusion: </strong>Use of rescue BCG was associated with reduced risk of progression and improved overall survival when compared to No Rescue BCG. There was no significant difference in PFS between the No Rescue BCG cohort and in patients who had a HG recurrence within 2 years of being treated with Rescue BCG suggesting that a trial of Rescue BCG does not compromise overall oncologic outcomes.</p>","PeriodicalId":23408,"journal":{"name":"Urologic Oncology-seminars and Original Investigations","volume":" ","pages":""},"PeriodicalIF":2.3000,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Revisiting BCG: The potential of rescue BCG therapy for BCG-unresponsive non-muscle-invasive bladder cancer.\",\"authors\":\"Ketty Bai, Srinath-Reddi Pingle, Rainjade Chung, Benjamin I Joffe, Caroline Laplaca, G Joel Decastro, James M McKiernan, Christopher B Anderson, Andrew T Lenis\",\"doi\":\"10.1016/j.urolonc.2025.08.007\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To evaluate the role of Rescue BCG in the treatment of BCG-unresponsive nonmuscle-invasive bladder cancer (NMIBC), in order to inform clinical decision-making especially when access to alternative therapies is limited.</p><p><strong>Methods: </strong>From an institutional database, patients who met the criteria of BCG-unresponsive NMIBC between 2002 and 2023 were identified and sorted into 2 cohorts: those who received additional BCG therapy immediately after BCG-unresponsive designation and those who received alternative treatments such as intravesical chemotherapy and radical cystectomy. Primary endpoint was progression-free survival (PFS). Secondary endpoints included high-grade (HG) recurrence-free survival (RFS) and overall survival (OS).</p><p><strong>Results: </strong>A total of 120 patients with BCG-unresponsive NMIBC were evaluated. Of these, 66 received Rescue BCG, and 54 did not. Both cohorts were similar in demographics, although the Rescue BCG cohort had significantly more HG T1 disease. The 1-year PFS for Rescue BCG was 95.3% compared with 84.5% for No Rescue BCG (log rank, P = 0.4). Multivariable analyses showed Rescue BCG significantly reduced disease progression (HR: 0.38, 95% CI, 0.14-0.99) and improved overall survival (HR: 0.18, 95% CI, 0.04-0.79), though no difference in HG recurrence was found. Limitations include retrospective design.</p><p><strong>Conclusion: </strong>Use of rescue BCG was associated with reduced risk of progression and improved overall survival when compared to No Rescue BCG. There was no significant difference in PFS between the No Rescue BCG cohort and in patients who had a HG recurrence within 2 years of being treated with Rescue BCG suggesting that a trial of Rescue BCG does not compromise overall oncologic outcomes.</p>\",\"PeriodicalId\":23408,\"journal\":{\"name\":\"Urologic Oncology-seminars and Original Investigations\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2025-09-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Urologic Oncology-seminars and Original Investigations\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.urolonc.2025.08.007\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Urologic Oncology-seminars and Original Investigations","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.urolonc.2025.08.007","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
Revisiting BCG: The potential of rescue BCG therapy for BCG-unresponsive non-muscle-invasive bladder cancer.
Objective: To evaluate the role of Rescue BCG in the treatment of BCG-unresponsive nonmuscle-invasive bladder cancer (NMIBC), in order to inform clinical decision-making especially when access to alternative therapies is limited.
Methods: From an institutional database, patients who met the criteria of BCG-unresponsive NMIBC between 2002 and 2023 were identified and sorted into 2 cohorts: those who received additional BCG therapy immediately after BCG-unresponsive designation and those who received alternative treatments such as intravesical chemotherapy and radical cystectomy. Primary endpoint was progression-free survival (PFS). Secondary endpoints included high-grade (HG) recurrence-free survival (RFS) and overall survival (OS).
Results: A total of 120 patients with BCG-unresponsive NMIBC were evaluated. Of these, 66 received Rescue BCG, and 54 did not. Both cohorts were similar in demographics, although the Rescue BCG cohort had significantly more HG T1 disease. The 1-year PFS for Rescue BCG was 95.3% compared with 84.5% for No Rescue BCG (log rank, P = 0.4). Multivariable analyses showed Rescue BCG significantly reduced disease progression (HR: 0.38, 95% CI, 0.14-0.99) and improved overall survival (HR: 0.18, 95% CI, 0.04-0.79), though no difference in HG recurrence was found. Limitations include retrospective design.
Conclusion: Use of rescue BCG was associated with reduced risk of progression and improved overall survival when compared to No Rescue BCG. There was no significant difference in PFS between the No Rescue BCG cohort and in patients who had a HG recurrence within 2 years of being treated with Rescue BCG suggesting that a trial of Rescue BCG does not compromise overall oncologic outcomes.
期刊介绍：
Urologic Oncology: Seminars and Original Investigations is the official journal of the Society of Urologic Oncology. The journal publishes practical, timely, and relevant clinical and basic science research articles which address any aspect of urologic oncology. Each issue comprises original research, news and topics, survey articles providing short commentaries on other important articles in the urologic oncology literature, and reviews including an in-depth Seminar examining a specific clinical dilemma. The journal periodically publishes supplement issues devoted to areas of current interest to the urologic oncology community. Articles published are of interest to researchers and the clinicians involved in the practice of urologic oncology including urologists, oncologists, and radiologists.
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