With the ongoing shortage of BCG remaining an issue for urologists in the UK and further afield, this topical paper presented the results of the CUETO study evaluating the outcome of a modified three-year BCG maintenance regimen versus induction therapy alone in patients with high-risk non-muscle-invasive bladder cancer. In the study, patients were randomised to receive either BCG induction once weekly for six weeks, or BCG induction followed by maintenance, involving a single BCG instillation every three months for three years. Primary endpoints were disease-free interval and time to progression, with secondary endpoints including survival duration and toxicity. Three hundred and ninety-seven patients were randomised in total. Both disease-free interval and time to progression were similar between the two groups. There was also no significant difference in overall and cancer-specific five-year survival. A higher number of patients stopped treatment due to toxicity in the maintenance group. In view of the current shortage, the results of this study are promising. However the maintenance schedule used in the study varies considerably from the standard SWOG schedule, therefore the results of the study need to be considered with caution. 

Maintenance therapy with 3-monthly bacillus Calmette-Guérin for 3 years is not superior to standard induction therapy in high-risk non-muscle-invasive urothelial bladder carcinoma: final results of randomised CUETO study 98013.
Martínez-Piñeiro L, Portillo JA, Fernández JM, et al.
2015; [Epub ahead of print].
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Sophia Cashman

Cambridge University Hospitals NHS Foundation Trust.

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