Witjes - Figure 20
Dose/schedule reduction
FIG. 20: This Figure shows the results of a large study from the European Organization for Research and Treatment of Cancer (EORTC) Genito-Urinary Group in around 1300 patients randomized to 4 different BCG treatment schedules and doses.[9] One group was treated with 1/3 dosage over 1 year, a second group had full-dose treatment over 1 year, a third group had a 1/3 dose over 3 years, and the fourth group had full dose over 3 years. As can be seen in the Figure, there was no significant difference in recurrence rate or disease-free survival between the 4 groups: progression rates, cancer-specific mortality, and toxicity were the same.
This significant “no difference” means that we can quite safely save some BCG without much risk of bladder cancer progression.
References
Oddens J, Brausi M, Sylvester R, et al. Final results of an EORTC-GU Cancers Group randomized study of maintenance bacillus Calmette-Guérin in intermediate- and high-risk Ta, T1 papillary carcinoma of the urinary bladder: one-third dose versus full dose and 1 year versus 3 years of maintenance. Eur Urol. 2013;63:462−72 http://dx.doi.org/10.1016/j.eururo.2012.10.039