Login to Access Video or Poster Abstract: MP15-08
Sources of Funding: None

Introduction

For most patients with pT1 and Carcinoma in situ (CIS) urothelial carcinoma of the bladder (UCB), intravesical induction Bacillus Calmette Guérin (IND-BCG) is considered the gold standard treatment. However the criteria to abandon BCG therapy (i.e. BCG failure) in cases of recurrent but non-progressive UC can be vague. _x000D_ In this study we aim to assess a large cohort of CIS and pT1 UCB patients treated with intravesical IND-BCG and report on the outcomes according to the grade and stage of recurrences following IND-BCG._x000D_

Methods

The data is from a single academic institution which is the only referral site for all BCG therapies for a large metropolitan area. Patients with initial diagnosis of pT1 and CIS received induction course of intravesical BCG. Post induction cystoscopy was carried out for all patients, and follow up was three monthly for the first two years, and at least biannually thereafter.

Results

From 2001 to 2014, 261 patients received IND-BCG for pT1/CIS. Post BCG status were as follows: 132 (51%) pT0, 48 (18%) CIS, 31 (12%) pT1, 32 (12%) pTaHG and 10 (4%) pTaLG. _x000D_ Of the patients who were pT0 post-BCG, 74% remained disease free at a median of 8 mo. 19% developed high-grade recurrences including 4% with muscle invasive UC (MIUC) at a median of 16 mo (12-27) from diagnosis. Of patients with residual CIS, 60% responded to further BCG, with progression to invasive disease in 13%. _x000D_ Of residual pTaHG patients, 53% became pT0 and 9% eventually had cystectomy at 32.4 mo for disease progression to CIS or ?pT1. 10 patients had pTa-LG recurrence and one required cystectomy. _x000D_ Only 36% of residual pT1 patients became pT0 with 29% developing invasive disease. 39% of pT1 compared to 17% of the CIS required cystectomy at a median of 17.5 mo (p=0.036). _x000D_ pT0 rates were significantly higher for CIS patients compared to pT1 (60% vs. 36%, 0.047), but similar between CIS and pTaHG. _x000D_ _x000D_

Conclusions

Non-invasive recurrence of high grade UC following BCG may respond to further intravesical therapy however response is less likely in recurrent pT1 UC. Following BCG recurrent non-invasive high

Funding

None