{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T03:45:14Z","timestamp":1770435914389,"version":"3.49.0"},"reference-count":20,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2012,12,17]],"date-time":"2012-12-17T00:00:00Z","timestamp":1355702400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2013,5]]},"abstract":"\n What's known on the subject? and What does the study add?<\/jats:title>\n \n \n \n \n Non\u2010muscle\u2010invasive bladder cancer has a significant recurrence and progression rate despite transurethral resection. The current standard of care to lower the risk of recurrence and progression is adjuvant\n BCG<\/jats:styled-content>\n followed by maintenance\n BCG<\/jats:styled-content>\n . Despite this, a significant number of patients experience recurrence and progress to invasive cancer. Several randomized trials have studied combination therapy (\n BCG<\/jats:styled-content>\n with chemotherapy) to try to reduce the recurrence and progression rate.\n <\/jats:p>\n <\/jats:list-item>\n \n \n We performed a systematic review with meta\u2010analysis and found that adjuvant\n BCG<\/jats:styled-content>\n followed by maintenance therapy is the appropriate standard of care when compared with combination therapy. We conclude that further trials are warranted to test the effects of adding chemotherapy to\n BCG<\/jats:styled-content>\n in patients with\n Ta<\/jats:styled-content>\n or\n T1<\/jats:styled-content>\n disease, but not in those with Tis alone.\n <\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n \n \n \n \n To determine if the combination of intravesical chemotherapy and maintenance bacille\n C<\/jats:styled-content>\n almette\u2010\n G<\/jats:styled-content>\n u\u00e9rin (\n BCG<\/jats:styled-content>\n ), used in sequence, is superior to maintenance\n BCG<\/jats:styled-content>\n alone in the treatment of non\u2010muscle\u2010invasive bladder cancer (\n NMIBC<\/jats:styled-content>\n ).\n <\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n \n \n \n We searched biomedical literature databases for randomized controlled trials that compared sequential, intravesical chemotherapy added to maintenance\n BCG<\/jats:styled-content>\n with maintenance\n BCG<\/jats:styled-content>\n alone.\n <\/jats:p>\n <\/jats:list-item>\n \n \n Studies that did not use maintenance\n BCG<\/jats:styled-content>\n were excluded.\n <\/jats:p>\n <\/jats:list-item>\n \n The meta\u2010analysis was performed using the fixed effects model.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n \n \n Four trials were identified, including 801 patients.<\/jats:p>\n <\/jats:list-item>\n \n \n Adding chemotherapy to maintenance\n BCG<\/jats:styled-content>\n did not result in a significant reduction in recurrence (relative risk [\n RR<\/jats:styled-content>\n ] 0.92; 95% confidence interval [\n CI<\/jats:styled-content>\n ] 0.79\u20131.09;\n P<\/jats:italic>\n = 0.32) or progression (\n RR<\/jats:styled-content>\n 0.88; 95%\n CI<\/jats:styled-content>\n 0.61\u20131.27;\n P<\/jats:italic>\n = 0.5).\n <\/jats:p>\n <\/jats:list-item>\n \n \n The risk of recurrence (\n RR<\/jats:styled-content>\n 0.75; 95%\n CI<\/jats:styled-content>\n 0.61\u20130.92;\n P<\/jats:italic>\n = 0.006) and progression (\n RR<\/jats:styled-content>\n 0.45; 95%\n CI<\/jats:styled-content>\n 0.25\u20130.81;\n P<\/jats:italic>\n = 0.007) were reduced when the single trial that included isolated Tis was excluded.\n <\/jats:p>\n <\/jats:list-item>\n \n Toxicity was similar for both groups.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n \n \n \n Adjuvant therapy with induction\n BCG<\/jats:styled-content>\n followed by maintenance\n BCG<\/jats:styled-content>\n is the appropriate standard of care for patients with resected\n NMIBC<\/jats:styled-content>\n at high risk of recurrence.\n <\/jats:p>\n <\/jats:list-item>\n \n \n Further trials are warranted to test the effects of adding chemotherapy to\n BCG<\/jats:styled-content>\n in patients with\n Ta<\/jats:styled-content>\n or\n T1<\/jats:styled-content>\n disease, but not in those with\n Tis<\/jats:styled-content>\n alone.\n <\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/j.1464-410x.2012.11390.x","type":"journal-article","created":{"date-parts":[[2012,12,18]],"date-time":"2012-12-18T12:22:14Z","timestamp":1355833334000},"page":"977-983","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":46,"title":["Intravesical chemotherapy plus bacille\n C<\/scp>\n almette\u2010\n G<\/scp>\n u\u00e9rin in non\u2010muscle invasive bladder cancer: a systematic review with meta\u2010analysis"],"prefix":"10.1111","volume":"111","author":[{"given":"Baerin B.","family":"Houghton","sequence":"first","affiliation":[{"name":"National Health and Medical Research Council Clinical Trials Centre University of Sydney Sydney NSW Australia"},{"name":"Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group Ltd Sydney NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Venu","family":"Chalasani","sequence":"additional","affiliation":[{"name":"National Health and Medical Research Council Clinical Trials Centre University of Sydney Sydney NSW Australia"},{"name":"Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group Ltd Sydney NSW Australia"},{"name":"Northern Sydney Local Health District Sydney NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dickon","family":"Hayne","sequence":"additional","affiliation":[{"name":"School of Surgery University of Western Australia Perth WA Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Grimison","sequence":"additional","affiliation":[{"name":"Sydney Cancer Centre Sydney NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher S. B.","family":"Brown","sequence":"additional","affiliation":[{"name":"National Health and Medical Research Council Clinical Trials Centre University of Sydney Sydney NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manish I.","family":"Patel","sequence":"additional","affiliation":[{"name":"Urological Cancers Outcomes Centre University of Sydney Sydney NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian D.","family":"Davis","sequence":"additional","affiliation":[{"name":"Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group Ltd Sydney NSW Australia"},{"name":"Monash University Melbourne Vic. Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin R.","family":"Stockler","sequence":"additional","affiliation":[{"name":"National Health and Medical Research Council Clinical Trials Centre University of Sydney Sydney NSW Australia"},{"name":"Sydney Cancer Centre Sydney NSW Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2012,12,17]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.20107"},{"key":"e_1_2_8_3_1","volume-title":"Global Cancer Facts & Figures","author":"American Cancer Society","year":"2011"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/00365590801948166"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/003655900750016698"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(17)35397-1"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2005.07.062"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1464-410x.1998.00628.x"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/0959-8049(95)00287-S"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcb.240501307"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(17)58737-6"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199110243251703"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(17)55150-2"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2008.04.051"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(05)70472-1"},{"key":"e_1_2_8_16_1","doi-asserted-by":"crossref","unstructured":"HigginsJ GreenS.Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2: the Cochrane Collaboration.2009","DOI":"10.1002\/9780470712184"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(05)68555-2"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2008.03.038"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0302-2838(03)00140-4"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(05)67707-5"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ju.0000173919.28835.aa"}],"container-title":["BJU International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fj.1464-410X.2012.11390.x","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/bjui-journals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/j.1464-410X.2012.11390.x","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T14:37:35Z","timestamp":1761748655000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjui-journals.onlinelibrary.wiley.com\/doi\/10.1111\/j.1464-410X.2012.11390.x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,12,17]]},"references-count":20,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2013,5]]}},"alternative-id":["10.1111\/j.1464-410X.2012.11390.x"],"URL":"https:\/\/doi.org\/10.1111\/j.1464-410x.2012.11390.x","archive":["Portico"],"relation":{},"ISSN":["1464-4096","1464-410X"],"issn-type":[{"value":"1464-4096","type":"print"},{"value":"1464-410X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,12,17]]},"assertion":[{"value":"2012-12-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}