title: The Moreau Strain of Bacillus Calmette-Guerin (BCG) for High-Risk Non-Muscle Invasive Bladder Cancer: An Alternative during Worldwide BCG Shortage?
abstract: BACKGROUND
  Bacillus Calmette-Guerin (BCG) is the standard of care for adjuvant intravesical instillation therapy for intermediate- and high-risk non-muscle invasive bladder cancer (NMIBC) after complete transurethral resection. Increasing evidence suggests that there are marked differences in outcomes according to BCG substrains. BCG-Moreau was recently introduced to the European market to cover the issue of BCG shortage, but there are little data regarding the oncologic efficacy.
  
  
  METHODS
  We retrospectively analyzed 295 consecutive patients, who received adjuvant intravesical instillation therapy with BCG-Moreau for intermediate- and high-risk NMIBC between October 2007 and April 2013 at a single institution. The end points of this study were time to first recurrence and progression to muscle-invasive disease.
  
  
  RESULTS
  Median age was 66 years (interquartile range 59-74, mean 65.9 years). According to the EAU risk group, 76 patients presented with intermediate-risk and 219 patients with high-risk NMIBC. The 5-year recurrence-free survival and progression-free survival rate was 64.8% (95% CI 52.8-74.4) and 81.4% (95% CI 65.2-90.2), respectively.
  
  
  CONCLUSIONS
  BCG-Moreau is an effective substrain for adjuvant instillation therapies of NMIBC, and outcomes appear to be comparable to series using other substrains. During worldwide shortage of BCG-TICE, Connaught and RIVM, BCG-Moreau may serve as an equally effective alternative.
authors.affiliation: Department of Urology, Medical University of Vienna and General Hospital, Vienna, Austria.
authors.forename: Sebastian L
authors.initials: SL
authors.lastname: Hofbauer
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Daher C
authors.initials: DC
authors.lastname: Chade
authors.forename: Alvaro S
authors.initials: AS
authors.lastname: Sarkis
authors.forename: Leopoldo A
authors.initials: LA
authors.lastname: Ribeiro-Filho
authors.forename: Willian C
authors.initials: WC
authors.lastname: Nahas
authors.forename: Tobias
authors.initials: T
authors.lastname: Klatte
mesh_terms: D000283:Administration, Intravesical; D000368:Aged; D001500:BCG Vaccine / Q000600:supply & distribution* / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D018450:Disease Progression; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D057915:Drug Substitution; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000601:surgery*
chemical_list: D001500:BCG Vaccine