title: Efficacy of bacillus Calmette-Guérin Strains for Treatment of Nonmuscle Invasive Bladder Cancer: A Systematic Review and Network Meta-Analysis.
abstract: We sought to determine the efficacy of genetically distinct bacillus Calmette-Guérin strains in preventing disease recurrence in patients with nonmuscle invasive bladder cancer.
  
  
  
  We conducted a systematic review and network meta-analysis of trials evaluating bacillus Calmette-Guérin strains against all possible comparators (different bacillus Calmette-Guérin strains, chemotherapy and nonbacillus Calmette-Guérin biological therapies) with intravesical chemotherapy as the common comparator. MEDLINE® (http://www.ncbi.nlm.nih.gov/pubmed) served as the primary data source, with the search from inception to October 2016 for clinical trials involving patients with nonmuscle invasive bladder cancer receiving bacillus Calmette-Guérin. Primary outcome measure was bladder cancer recurrence, defined as recurrent bladder tumor of any grade or stage. Random effect network meta-analysis provided estimates for outcomes and is presented as odds ratios.
  
  
  
  Across all possible comparators (65 trials, 12,246 patients, 9 strains) there were 2,177 recurrences in 5,642 treated patients (38.6%) and 2,316 recurrences in 5,441 comparators (42.6%). With chemotherapy as the common comparator (28 trials, 5,757 patients, 5 strains) Tokyo-172 (OR 0.39, 95% CI 0.16-0.93), Pasteur (OR 0.49, 95% CI 0.28-0.86) and TICE® (OR 0.61, 95% CI 0.40-0.93) strains were significantly better than chemotherapy at preventing recurrence. No bacillus Calmette-Guérin strain demonstrated significant superiority when compared to any other strain at preventing recurrence in the network meta-analysis.
  
  
  
  Bacillus Calmette-Guérin strains exhibited significant differences in efficacy compared to chemotherapy. However, no definitive conclusions could be reached regarding strain superiority, and head-to-head trials are greatly needed to further understand the importance of strain selection in determining bacillus Calmette-Guérin efficacy.
authors.affiliation: Department of Urology, University of Texas Health San Antonio, San Antonio, Texas; Department of Biostatistics (JEC), University of Texas Health San Antonio, San Antonio, Texas.
authors.forename: Brock E
authors.initials: BE
authors.lastname: Boehm
authors.affiliation: Department of Urology, University of Texas Health San Antonio, San Antonio, Texas; Department of Biostatistics (JEC), University of Texas Health San Antonio, San Antonio, Texas.
authors.forename: John E
authors.initials: JE
authors.lastname: Cornell
authors.affiliation: Department of Urology, University of Texas Health San Antonio, San Antonio, Texas; Department of Biostatistics (JEC), University of Texas Health San Antonio, San Antonio, Texas.
authors.forename: Hanzhang
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Urology, University of Texas Health San Antonio, San Antonio, Texas; Department of Biostatistics (JEC), University of Texas Health San Antonio, San Antonio, Texas.
authors.forename: Neelam
authors.initials: N
authors.lastname: Mukherjee
authors.affiliation: Department of Urology, University of Texas Health San Antonio, San Antonio, Texas; Department of Biostatistics (JEC), University of Texas Health San Antonio, San Antonio, Texas.
authors.forename: Jacob S
authors.initials: JS
authors.lastname: Oppenheimer
authors.affiliation: Department of Urology, University of Texas Health San Antonio, San Antonio, Texas; Department of Biostatistics (JEC), University of Texas Health San Antonio, San Antonio, Texas. Electronic address: svatek@uthscsa.edu.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Svatek
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D001500:BCG Vaccine / Q000627:therapeutic use*; D006801:Humans; D009163:Mycobacterium bovis; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology
chemical_list: D000276:Adjuvants, Immunologic; D001500:BCG Vaccine
keywords: BCG vaccine; immunotherapy; urinary bladder neoplasms