Moderated Poster Session

MP63-19: Adequate vs inadequate BCG intravesical therapy in intermediate and high risk NMIBC: total number of instillations is what really matters

Poster Presenter(s)

• Md

  Mario de Angelis

Introduction: Intravesical immunotherapy with Bacillus Calmette-Guérin (BCG) is currently recommended by EAU guidelines for proper treatment of patients with intermediate (IR) and high risk (HR) non-muscle invasive bladder cancer (NMIBC). We aimed to verify if complete adherence to BCG therapy relates to better oncological outcomes in terms of risk of recurrence and progression

Methods: We retrospectively identified 250 patients who underwent transurethral resection of bladder cancer between 2012 and 2022 at a tertiary referral centre. All these patients were diagnosed with IR or HR NMIBC and treated with BCG according to EAU guidelines. We evaluated if intravesical treatment was adequate, defined as at least 1 year of maintenance in IR patients and 3 years in HR patients. Multivariable analyses (MVA) tested the impact of number of instillations and therapy adequateness on recurrence and progression. Recurrence and progression were compared with the Kaplan-Meier (KM) analysis according to intravesical therapy adequateness

Results: 45 patients (18%) received adequate intravesical therapy according to their class of risk. Patients with adequate treatment received about triple the amount of instillations compared with inadequately treated ones (21 vs 9). Median FU was 42 months. In this period, 75 patients showed disease recurrence, 62 of which were treated inadequately (83%). Similarly, 93% of progressions concerned patients treated inadequately. At MVA, both total number of instillations and proper treatment were related with disease progression (HR 0.92, p=0.015 vs HR 0.22, p=0.041). Conversely, recurrence was only associated with total number of instillation (HR 0.95, p=0.019). KM analysis shows how at 2 years follow-up, progression free survival was higher in patients who received adequate treatment compared with those treat inadequately (96%vs 83%)

Conclusions: A more intense BCG instillation regime is associated with lower risk of recurrence and progression of bladder cancer. In particular, a higher amount of instillations seems to be more related with tumor recurrence and progression. These results confirm the hypothesis that too often real life differ from guidelines, resulting in an actual undertreatment of these patients and the consequent worsening of the disease SOURCE OF

Funding: none