Journal article
Quadruple immunotherapy of Bacillus Calmette-Guérin, interferon, interleukin-2, and granulocyte-macrophage colony-stimulating factor as salvage therapy for non–muscle-invasive bladder cancer
Urologic oncology, Vol.35(12), pp.670.e7-670.e14
12/2017
DOI: 10.1016/j.urolonc.2017.07.024
PMID: 28801026
Abstract
Bacillus Calmette-Guérin (BCG) is the most effective initial intravesical therapy for high-grade non–muscle invasive bladder cancer, but many patients still fail. Combination intravesical BCG and interferon (IFN) will salvage some patients but results remain suboptimal.
We hypothesized that further immunostimulation with intravesical interleukin-2 and subcutaneous granulocyte-macrophage colony-stimulating factor may improve response to intravesical BCG and IFN in patient with prior BCG failure(s).
A retrospective review was performed. Patients received 6 treatments of quadruple immunotherapy (intravesical solution with one-third dose BCG, 50 million units IFN, and 22 million units interleukin-2, along with a 250-mcg subcutaneous sargramostim injection). Surveillance began 4 to 6 weeks after treatment completion. Patients received maintenance if recurrence-free. Success was defined as no recurrence (bladder or extravesical) and bladder preservation. Analysis was performed by Kaplan-Meier method (P<0.05).
Fifty-two patients received treatment with a median recurrence follow-up of 16.3 months and overall follow-up of 41.8 months. All patients had at least 1 prior BCG failure and 13% had 2 or more prior failures. Only 3 patients (6%) were unable to tolerate full induction. Treatment success was 55% at 1 year, and 53% at 2 years. Thirteen patients (25%) underwent cystectomy at a median time of 17.3 months with disease progression to T2 in 1 patient and T3 in 2 patients. No patients had positive surgical margins or positive lymph nodes.
In patients with non–muscle-invasive bladder cancer with prior BCG failure, quadruple immunotherapy demonstrated good treatment success in some patients and warrants further evaluation.
.
•Incomplete immunostimulation has been proposed as a cause of BCG failure.•A total of 52 patients treated with quadruple immunotherapy were retrospectively reviewed.•A total of 53% of patients were disease-free 2 years after induction and maintenance therapy.•Quadruple immunotherapy was effective and warrants further comparative evaluation.
Details
- Title: Subtitle
- Quadruple immunotherapy of Bacillus Calmette-Guérin, interferon, interleukin-2, and granulocyte-macrophage colony-stimulating factor as salvage therapy for non–muscle-invasive bladder cancer
- Creators
- Ryan L Steinberg - Department of Urology, University of Iowa, Iowa City, IAKenneth G Nepple - Department of Urology, University of Iowa, Iowa City, IAKyla N Velaer - Department of Urology, Stanford University, Palo Alto, CALewis J Thomas - Department of Urology, University of Iowa, Iowa City, IAMichael A O'Donnell - Department of Urology, University of Iowa, Iowa City, IA
- Resource Type
- Journal article
- Publication Details
- Urologic oncology, Vol.35(12), pp.670.e7-670.e14
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.urolonc.2017.07.024
- PMID
- 28801026
- ISSN
- 1078-1439
- eISSN
- 1873-2496
- Grant note
- name: NIH; name: CTSA
- Language
- English
- Date published
- 12/2017
- Academic Unit
- Urology
- Record Identifier
- 9984051773002771
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