Clinical outcomes of chemotherapy with or without intravesical BCG in NMIBC patients: A Bayesian network meta-analysis.

Abstract

e16599 Background: Non-muscle-invasive bladder cancer (NMIBC) is a recurrent urinary bladder malignancy traditionally treated with intravesical Bacillus Calmette–Guérin (BCG). Newer chemotherapeutics combined with BCG may enhance efficacy and safety, though clinical outcomes remain less-explored. We evaluated BCG monotherapy versus combination therapies through systematic review and network meta-analysis. Methods: A systematic literature search of 4 databases identified primary studies on chemotherapeutics with or without BCG in NMIBC. A Bayesian network meta-analysis was performed in R with pooled risk ratios (RR) with 95% credible intervals (CrI) using random or common effects models based on the Deviance Information Criterion (DIC), with quantification of surface under the cumulative ranking (SUCRA). Results: Our analysis included 19 studies (7,514 patients). For Complete Response (CR), Radiofrequency-Induced Thermo-chemotherapeutic Effect Mitomycin C (RITE-MMC) ranked highest (SUCRA: 91.22) but was less effective than BCG (RR: 0.52, CrI: 0.20–1.30). Chemohyperthermia (CHT), Sequential MMC+BCG and hyperthermic intravesical chemotherapy (HIVEC) showed comparable efficacy to BCG (RRs: 1.04, 1.05). HIVEC (RR: 0.11, CrI: 0.00–0.66, SUCRA: 87) and titanium glycerosolvate aquacomplex (TGA) (RR: 0.11, CrI: 0.00–0.76, SUCRA: 86.26) demonstrated superior efficacy in Progressive Disease (PD). For Recurrence Rate (RR), Neoadjuvant electromotive MMC (EMDA)+BCG ranked highest (SUCRA: 83.51, RR: 0.22, CrI: 0.02–2.19), followed by Sequential MMC+BCG (SUCRA: 65.82). Sequential MMC+BCG (SUCRA: 100, RR: 0.48, CrI: 0.35–0.67) significantly outperformed BCG (SUCRA: 62.77) in prolonging Recurrence-Free Survival (RFS). Conclusions: Our findings demonstrated Sequential MMC+BCG shows promise for improving recurrence-free survival and recurrence rates. HIVEC and intravesical gemcitabine demonstrated superior safety with fewer adverse events, offering valuable insights to optimize NMIBC treatment strategies. Outcome/Intervention (RR, CrI, SUCRA value) Neoadjuvant EMDA+BCG RITE Sequential MMC+BCG HIVEC BEXIDEM IV-Thiotepa BCG (SUCRA) Intravesical gemcitabine PD - - 0.51,0.30-0.85,55.65 0.11,0.00-0.66,87 - 1.03,0.62-1.72,17.22 17.95 0.49,0.13-1.53,53.64 RR 0.22,0.02-2.19,83.51 0.56,0.07-4.62,61.61 0.52,0.12-2.33,65.82 0.49,0.05-4.94,64.49 2.84,0.33-24.59,16.44 0.67,0.08-5.43,56.27 40.52 0.64,0.14-2.95,58.28 RFS - - 0.48,0.35-0.67,100 1.18,0.94-1.53,19.67 - - 62.77 NA Total Adverse Events - - 0.68,0.06-7.97,50.51 0.42,0.06-2.43,66.58 - 0.81,0.07-9.78,45.37 35.44 0.16,0.01-2.17,84.35 Hematuria 0.48,0.06-2.38,63.59 1.01,0.60-1.69,32.56 - 0.28,0.01-2.34,75.27 - 0.31,0.04-1.31,78.03 34.18 0.42,0.01-5.11,62.65 Dysuria - 0.85,0.14-4.93,39.37 - - 0.29,0.04-1.81,76.61 0.43,0.05-3.21,63.15 28.5 -