The impact of age on the response of patients with superficial bladder cancer to intravesical immunotherapy

J Urol. 2006 May;175(5):1634-9; discussion 1639-40. doi: 10.1016/S0022-5347(05)00973-0.

Abstract

Purpose: We determined the influence of age on response to intravesical immunotherapy in patients with superficial bladder cancer.

Materials and methods: Data from a national phase II multicenter trial for BCG plus IFN-alpha intravesical therapy for superficial bladder cancer were analyzed. Recurrence-free survival 2 years after the initiation of therapy was examined in patients by incremental age decade. BCG-N patients received 81 mg BCG and 50 MU IFN-alpha, while patients who had previously been treated with BCG received a third of the BCG dose with 50 MU IFN-alpha and those who were BCG intolerant received a tenth of the BCG dose with 100 MU IFN-alpha. Kaplan-Meier survival curves were obtained.

Results: In all patients the largest difference in response was between the 289 who were 61 to 70 years old and the 123 who were older than 80 years with a 22% difference in cancer-free survival at a median followup of 24 months (61% vs 39%, p = 0.0002). When we assessed BCG-N and BCG treated patients separately in the 2 age groups, patients older than 80 years had a persistently lower response rate than younger patients 61 to 70 years old. Of BCG-N patients those older than 80 and younger than 50 years had the lowest cancer-free survival at a median followup of 24 months (47% and 45%, respectively). On multivariate analysis age was an independent risk factor for response.

Conclusions: Aging appears to be associated with a decreased response to intravesical immunotherapy and is particularly apparent in patients older than 80 years. A potential explanation could be their depressed baseline immune status and consequent inability to mount an immune reaction to BCG or IFN-alpha.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adjuvants, Immunologic / administration & dosage*
  • Administration, Intravesical
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / administration & dosage*
  • BCG Vaccine / administration & dosage*
  • Carcinoma, Transitional Cell / drug therapy*
  • Female
  • Humans
  • Immunotherapy / methods
  • Interferon-alpha / administration & dosage*
  • Male
  • Middle Aged
  • Urinary Bladder Neoplasms / drug therapy*

Substances

  • Adjuvants, Immunologic
  • Antineoplastic Agents
  • BCG Vaccine
  • Interferon-alpha