title: Bacillus Calmette-Guérin without maintenance therapy for high-risk non-muscle-invasive bladder cancer.
abstract: BACKGROUND
  Bacillus Calmette-Guérin (BCG) is the standard intravesical treatment of high-risk noninvasive (Ta, T1, Tis) bladder cancer. Maintenance BCG is recommended for maximum efficacy.
  
  
  OBJECTIVE
  We 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.
  
  
  METHODS
  A cohort of 1021 patients underwent restaging transurethral resection for high-risk (Ta, T1, Tis) bladder cancer.
  
  
  METHODS
  Patients 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.
  
  
  METHODS
  End points were 5-yr tumor- and progression-free survival rates.
  
  
  CONCLUSIONS
  Of 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.
  
  
  CONCLUSIONS
  Our 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.
authors.affiliation: Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. herrh@mskcc.org
authors.forename: Harry W
authors.initials: HW
authors.lastname: Herr
authors.forename: Guido
authors.initials: G
authors.lastname: Dalbagni
authors.forename: Sherri M
authors.initials: SM
authors.lastname: Donat
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001500:BCG Vaccine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000276:Adjuvants, Immunologic; D001500:BCG Vaccine