Durability of Response: The Achilles Heel of Salvage Combination Immunotherapy with Intravesical Bacillus Calmette Guerin and Interferon-Alpha 2B
Sandip M. Prasad, MD, Michaella M. Prasad, MD Stephen Eyre, MD, Kevin R. Loughlin, MD
Brigham and Womenís Hospital,
PURPOSE OF STUDY
The advent of intravesical immunotherapy therapy has significantly improved outcome in high-risk bladder tumors, but the natural history of these tumors following immunotherapy failure is unknown. We report our institutionís experience with bacillus Calmette-Guerin (BCG) alone and combined with interferon-α2B (INF) in regards to bladder cancer recurrence, disease progression, eventual cystectomy following initial BCG failure.
We identified a consecutive series of 139 patients undergoing intravesical instillations of BCG alone (n=114) or with interferon-α2B (n=25) performed at Brigham and Womenís Hospital,
SUMMARY OF RESULTS
At a median follow-up of 64.7 months from initial BCG administration, 84% treated with BCG + INF had disease recurrence. The average time to recurrence was less than one year, and 63% of these patients had recurrence on the first post-treatment biopsy.† Disease progression was seen in 48% of patient receiving BCG + INF therapy, and 28% of all patients eventually underwent radical cystectomy.† Only one patient died during this period.
Combination BCG + INF immunotherapy may have a short-term therapeutic benefit on cancer recurrence, but we did not find evidence that it significantly decreases disease progression.† Patients undergoing salvage intravesical interferon at our institution have greater than a 50% chance of recurrence and progression, and over one-quarter eventually proceed to radical cystectomy.†
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