NMI bladder cancer: which adjuvant intravesical therapy is best?

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  • Compared with transurethral resection of the bladder tumor (TURBT) alone, intravesical bacillus Calmette-Guérin (BCG), mitomycin C (MMC), doxorubicin, and epirubicin were associated with reduced recurrence risk in non-muscle-invasive bladder cancer (NMIBC).  

Why this matters

  • Evidence suggests underuse of adjuvant intravesical therapy, which may be influenced by uncertainty regarding optimal treatment strategies.

Key results

  • Adjuvant BCG was associated with decreased recurrence (relative risk [RR], 0.56; I2=0%) and progression (RR, 0.39; I2=40%) vs TURBT alone. 
  • 1 trial found a nonstatistically significant trend toward decreased mortality with BCG induction therapy (RR, 0.62). 
  • MMC was associated with decreased recurrence (RR, 0.68; I2=74%). 
  • MMC was effective as maintenance (RR, 0.71; I2=6.8%) or single instillation therapy (RR, 0.45; I2=79%). 
  • Doxorubicin, epirubicin, interferon-alpha, and interferon-gamma were associated with decreased...