title: Assessing the Feasibility of Replacing Standard-Dose Bacillus Calmette-Guérin Immunotherapy with Other Intravesical Instillation Therapies in Bladder Cancer Patients: A Network Meta-Analysis.
abstract: BACKGROUND
  Bacillus Calmette-Guérin (BCG) immunotherapy plays a key role in patients with bladder cancer. The shortage of intravesical BCG has motivated researchers to seek alternatives with equivalent efficacy If other alternative intravesical agents have equivalent efficacy compared to BCG, then it may be feasible to replace standard BCG with alternative options.
  
  
  METHODS
  We searched all relevant evidence in multiple sources and key data was extracted from included studies. Conventional and network meta-analysis were conducted so that pooled odds ratios (ORs) for the event of tumor recurrence and progression can be computed. The relative efficacy of different intravesical instillation procedures was computed by pooled odds ratios and their 95% confidence or creditable intervals. Besides, several key model assumptions were evaluated in our analysis.
  
  
  RESULTS
  Three intravesical instillation procedures have the potential for preventing tumor recurrence: standard-dose BCG (BCG_SD), Epirubicin (EPI) and Mitomycin C (MMC) (ORs < 1). Patients with BCG SD also exhibited a decreased risk of tumor recurrence and progression compared to those with EPI. No significant difference in the risk of tumor recurrence or progression was detected between patients treated with BCG_ SD and those with low-dose BCG (BCG_LD). Results of SUCRA indicated that BCG_EPI, BCG_ MMC and BCG SD had higher rankings with respect to tumor recurrence and progression.
  
  
  CONCLUSIONS
  BCG SD, EPI and MMC exhibited established efficacy for preventing tumor recurrence in postoperative BC patients. The efficacy of BCG may not be significantly reduced if standard dose was reduced to a lower level. However, there is no consensus suggesting that intravesical BCG with standard dose can be replaced by alternating or sequentially combined intravesical instillation therapies.
authors.affiliation: Department of Urology, People's Hospital of Dongtai City, Dongtai, China.
authors.forename: Cheng
authors.initials: C
authors.lastname: Wu
authors.affiliation: Department of Urology, People's Hospital of Dongtai City, Dongtai, China.
authors.forename: Xunrong
authors.initials: X
authors.lastname: Zhou
authors.affiliation: Department of Urology, People's Hospital of Dongtai City, Dongtai, China.
authors.forename: Chunqing
authors.initials: C
authors.lastname: Miao
authors.affiliation: Department of Urology, The first affiliated hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Jianzhong
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Urology, People's Hospital of Dongtai City, Dongtai, China.
authors.forename: Qingsheng
authors.initials: Q
authors.lastname: Tang
authors.affiliation: Department of Urology, People's Hospital of Dongtai City, Dongtai, China.
authors.forename: Xiumei
authors.initials: X
authors.lastname: Chang
authors.affiliation: Department of Urology, People's Hospital of Dongtai City, Dongtai, China.
authors.forename: Haodong
authors.initials: H
authors.lastname: Ni
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D015251:Epirubicin / Q000627:therapeutic use; D007167:Immunotherapy / Q000379:methods; D016685:Mitomycin / Q000627:therapeutic use; D009163:Mycobacterium bovis; D001749:Urinary Bladder Neoplasms / Q000276:immunology / Q000473:pathology / Q000628:therapy
chemical_list: D015251:Epirubicin; D016685:Mitomycin
keywords: Bacillus Calmette–Guérin; Consistency; Epirubicin; Gemcitabine; Heterogeneity; Interferon-Alpha; Intravesical instillation therapies; Mitomycin C; Pairwise/network meta-analysis; Tumor progression; Tumor recurrence