Open Access

ARTICLE

Treatment of BCG failures with intravesical BCG/ Interferon: the University of Montreal experience

Pierre I. Karakiewicz¹, Serge Benayoun^1,2, Daniel J. Lewinshtein^1,2, Felix K.-H. Chun¹, Khaled Shahrour², Paul Perrotte²

1 Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Quebec, Canada
2 Department of Urology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, Quebec, Canada
Address correspondence to Dr. Pierre I. Karakiewicz, Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, 1058, rue St-Denis, Montréal, Québec H2X 3J4 Canada

Canadian Journal of Urology 2006, 13(4), 3189-3194.

Abstract

Objective: Bacillus Calmette-Guerin (BCG) has shown promise in large scale studies. We assessed recurrencefree survival in patients treated with intravesical BCG/ Interferon (IFN) for non-muscle invasive, BCG refractory, transitional cell carcinoma (TCC) of the urinary bladder at our local institution. Methods: Cancer control data were gathered for patients enrolled in a BCG/Interferon protocol at the University of Montreal. The main inclusion criteria consisted of pathologically proven evidence of intravesical BCG failure, and of complete transurethral resection of latest post BCG recurrence. Induction consisted of eight intravesical BCG/Interferon instillations. Select patients were treated with BCG/Interferon maintenance therapy. Results: Thirteen patients aged from 45 to 81 years (mean: 65) were included. Stages at TCC diagnosis were distributed as follows: 6 (46%) CIS, 3 (23%) Ta, and 4 (31%) T1. Induction BCG consisted of an average of 11 weekly instillations (range 3-24). Prior to BCG/ Interferon stage distribution was as follows: 9 (69%) CIS, and 4 (31%) T1. BCG/Interferon maintenance was administered to 5 (38%) patients. Follow-up ranged from 1.5 to 32 months (mean=15, median=12). Recurrence was diagnosed in 5 patients (38%). Recurrence free survival (RFS) at 24 months was 66%. When stratified according to T stage prior to BCG/IFN, patients with CIS fared worse than T1 patients (50% versus 100%). Maintenance had no effect on RFS (75% versus 69%). Conclusions: Our results corroborate previous BCG/ IFN reports. In selected patients, intravesical BCG/IFN offers a valid alternative to definitive therapy.

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