Witjes - Figure 26

Sequential Therapy

FIG. 26:  There is one exclusion to the findings described in Figures 24 and 25.  This Figure shows a large Spanish study that also compared mitomycin plus BCG vs BCG alone.[14]  The BCG dose was the same in both, so these results are not really applicable if there is a BCG shortage.  As seen in the Figure, there were fewer recurrences on the sequential treatment arm, but there was also significantly higher toxicity. So the conclusion of this study was that sequential therapy might be an option, but probably only in the group that is at highest likelihood of recurrences, for example, high-grade T1 tumors.

References

[14]

Solsona E, Madero R, Chantada V, et al; Members of Club Urológico Español de Tratamiento Oncológico. Sequential combination of mitomycin C plus bacillus Calmette-Guérin (BCG) is more effective but more toxic than BCG alone in patients with non-muscle-invasive bladder cancer in intermediate- and high-risk patients: final outcome of CUETO 93009, a randomized prospective trial. Eur Urol. 2015;67:508−16  http://dx.doi.org/10.1016/j.urolonc.2013.02.010