Intra-Arterial Chemo Improves Outcomes in High-Risk Bladder Cancer

M. Alexander Otto, PA, MMS

August 22, 2022

The study was published on researchsquare.com as a preprint and has not yet been peer reviewed.

Key Takeaway

  • Adding intra-arterial chemotherapy to bacillus Calmette-Guérin (BCG) immunotherapy decreases rates of recurrence and progression in high-risk non–muscle-invasive bladder cancer (NMIBC), with little additional toxicity.

Why This Matters

  • Transurethral tumor resection followed by intravesical BCG therapy is standard treatment for patients with high-risk NMIBC.

  • However, up to 40% of patients experience relapse.

  • Intra-arterial chemotherapy, which delivers drugs directly to the tumor, has been shown to control micrometastasis in bladder cancer.

  • The study suggests that add-on intra-arterial chemotherapy reduces the recurrence risk with BCG, opening new avenues of treatment.

Study Design

  • Overall, 98 patients received intravesical BCG after resection; 45 also received four courses of intra-arterial cisplatin and epirubicin, which were delivered to local blood vessels.

  • Investigators compared outcomes in the two groups.

Key Results

  • Over a median follow-up of about 3 years, the recurrence rate was 22.2% in the BCG plus intra-arterial chemotherapy group, vs 35.8% with BCG alone.

  • The progression rate was 8.9% with combination therapy, vs 24.5% with stand-alone BCG.

  • On multivariate analysis, BCG plus intra-arterial chemotherapy was significantly better at preventing recurrence (P = .027) and progression (P = .024).

  • Intra-arterial chemotherapy led to adverse events in 10 patients (22%). All of the events were mild, and no patients withdrew before completing the four courses.

  • Most patients in both groups had adverse reactions to BCG. There were with no significant differences in BCG complications between the groups.

Limitations

  • It was a retrospective study with a small number of patients.

  • The follow-up period was relatively short.

Disclosures

  • The study was funded by the National Natural Science Foundation of China.

  • The authors have disclosed no relevant financial relationships.

This is a summary of a preprint research study, "Intra-Arterial Chemotherapy Plus BCG, a Promising Combination Adjuvant Treatment for High-Risk NMIBC," led by Shuhang Luo of Sun Yat-Sen University, China. The study has not been peer reviewed. The full text can be found at researchsquare.com.

M. Alexander Otto is a physician assistant with a master's degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who has worked for several major news outlets before joining Medscape and also an MIT Knight Science Journalism fellow. Email: aotto@mdedge.com.

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