Bacillus Calmette-Guérin Without Maintenance Therapy for High-Risk Non–Muscle-Invasive Bladder Cancer

BackgroundBacillus Calmette-Guérin (BCG) is the standard intravesical treatment of high-risk noninvasive (Ta, T1, Tis) bladder cancer. Maintenance BCG is recommended for maximum efficacy.ObjectiveWe compared our results in a large cohort of high-risk bladder cancer patients who received BCG without maintenance with published results from randomized maintenance BCG trials.Design, setting, and participantsA cohort of 1021 patients underwent restaging transurethral resection for high-risk (Ta, T1, Tis) bladder cancer.InterventionPatients received a 6-wk induction course of BCG therapy. Responding patients did not receive maintenance BCG. Relapsing patients were eligible for retreatment with BCG. All patients were followed for a minimum of 5 yr.MeasurementsEnd points were 5-yr tumor- and progression-free survival rates.Results and limitationsOf 816 complete responders to induction BCG, 2- and 5-yr recurrence-free survival rates were 73% and 46%, respectively. The progression-free survival rate was 89%. Progression-free survival time was 56 mo (95% confidence interval, 55–58 mo). Thirty-two percent of the patients required another course of BCG therapy. We cannot exclude that maintenance BCG may benefit patients beyond 5 yr over induction BCG alone and selective BCG retreatments.ConclusionsOur results with BCG treatment without maintenance of patients with high-risk non–muscle-invasive bladder cancer compare favorably with trials in which comparable patients received maintenance BCG.