Quality of Life in Patients with High-grade Non–muscle-invasive Bladder Cancer Undergoing Standard Versus Reduced Frequency of Bacillus Calmette-Guérin Instillations: The EAU-RF NIMBUS Trial

• Published in: European urology open science (Online) 2023-10, Vol.56, p.15-24
• Main Authors: van Straten, Christine G.J.I., Caris, Christien, Grimm, Marc-Oliver, Colombel, Marc, Muilwijk, Tim, Martínez-Piñeiro, Luis, Babjuk, Marko M., Türkeri, Levent N., Palou, Joan, Patel, Anup, Bjartell, Anders S., Witjes, Wim P.J., van der Heijden, Antoine G., Kiemeney, Lambertus A.L.M.
• Format: Article
• Language: English
• Subjects: Bacillus Calmette-Guérin; Bladder Cancer; High-grade non–muscle-invasive bladder cancer; Quality of life
• ISSN: 2666-1683; 2666-1691; 2666-1683
• DOI: 10.1016/j.euros.2023.08.004

This study did not find better quality of life with a reduction in the number of bacillus Calmette-Guérin instillations in patients with high-grade non–muscle-invasive bladder cancer. This result together with the previous finding that a reduced frequency schedule is inferior underlines the use of a standard bacillus Calmette-Guérin instillation schedule. Adverse events induced by intravesical bacillus Calmette-Guérin (BCG) to treat high-grade non–muscle-invasive bladder cancer (NMIBC) often lead to treatment discontinuation. The EAU-RF NIMBUS trial found a reduced number of standard-dose BCG instillations to be inferior with the standard regimen. Nonetheless, it remains important to evaluate whether patients in the reduced BCG treatment arm had better quality of life (QoL) due to a possible reduction in toxicity or burden. To evaluate whether patients in the EAU-RF NIMBUS trial experienced better QoL after a reduced BCG instillation frequency. A total of 359 patients from 51 European sites were randomized to one of two treatment arms between December 2013 and July 2019. The standard frequency arm (n = 182) was 6 weeks of BCG induction followed by 3 weeks of maintenance at months 3, 6, and 12. The reduced frequency arm (n = 177) was BCG induction at weeks 1, 2, and 6, followed by maintenance instillations at weeks 1 and 3 of months 3, 6, and 12. Analyses were performed using an intention-to-treat analysis and a per-protocol analysis. QoL was measured using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 version 3.0 (QLQ-C30 v.03) prior to the first and last instillations of each BCG cycle. Group differences were determined using linear regression corrected for QoL at baseline. Differences in QoL over time were tested for significance using a linear mixed model. Side effects were recorded by the treating physician using a standardized form. Chi-square tests were used to compare the side-effect frequency between the arms. There were no significant differences in the means of each QoL scale between the two arms. There were also no significant changes over time in all QoL domains for both arms. However, differences in the incidence of general malaise at T1 (before the last induction instillation), frequency, urgency, and dysuria at T7 (before the last maintenance instillation) were detected in favor of the reduced frequency arm. Reducing the BCG instillation frequency does not improve the QoL in NMIB