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Intravesical bacille Calmette–Guerin (BCG) therapy continues to be widely used for patients with intermediate / high-risk non-muscle invasive bladder cancer (NMIBC). In this article, the researchers identified the lack of sufficient evidence with regards to timing of BCG after transurethral resection of bladder tumour (TURBT). They conducted a retrospective review of patients after adequate BCG (at least five of six induction instillations plus at least two additional instillations, within a six-month period) to identify a co-relation between timing of BCG after TURBT with respect to efficacy (measured by recurrence-free survival (RFS), progression-free survival (PFS)) and tolerability. They divided a total of 518 patients into four quartiles based on timing of BCG after TURBT, namely Q1 (6-19 days), Q2 (20-26 days), Q3 (27-34 days), Q4 (35-188 days). They did not find any difference in RFS or PFS on Kaplan-Meier analysis. Univariate and multivariate analysis with time as a continuous variable did not show time to BCG to be a significant predictor with RFS of 1.00 (95% CI 0.99-1.00, P=0.449) and PFS of 0.99 (95% CI 0.98-1.00, P=0.074). It was interesting to note the administration of BCG within 19 days of TURBT in 153 patients, which is against traditional wisdom. The authors showed no significant difference between the groups in terms of BCG intolerance (9.15%, 7.91%, 9.52% and 8.26%, p=0.966). It was also noted that timing of BCG administration was not a predictor for BCG intolerance in univariate or multivariate analysis (0.99 (0.97–1.01), p=0.270). The authors also reported no cases of BCG sepsis in the Q1 group. The study, which sought to support early administration of BCG, has shown that the therapeutic response remains unchanged even if induction is delayed for up to six months. This is especially useful in the current scenario of COVID-19 and global BCG shortages.

Time interval from transurethral resection of bladder tumour to bacille Calmette–Guerin induction does not impact therapeutic response.
Hensley PJ, Bree KK, Brooks N, et al.
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Karthik Rajan

Morriston Hospital, Swansea, Wales.

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