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- Title
Fremantle protocol: Multicenter clinical outcomes for a pragmatic protocol for intravesical bacillus Calmette–Guerin.
- Authors
Tan, Kuok Liang; Viswambaram, Pravin; McCombie, Stephen; Moe, Andrew; Goodwin, Robert; Kuan, Melvyn; Ha, Tanya; Lozinskiy, Mikhail; Dyer, John; Hayne, Dickon
- Abstract
Objectives: To examine the utility and efficacy of a multifaceted protocol for the administration of intravesical bacillus Calmette–Guerin (BCG) for non‐muscle‐invasive bladder cancer (NMIBC). Subjects and methods: A multicenter retrospective review was conducted among 83 patients undergoing Fremantle protocol intravesical BCG for NMIBC within 4 major hospitals in Western Australia between January 2016 and December 2018. The Fremantle protocol consists of weekly BCG instillations for 6 weeks during the induction phase, followed by monthly BCG instillations for 10 months during the maintenance phase with integrated clearance‐to‐proceed algorithms for urine MSU checks, flexible cystoscopies performed at 3 monthly intervals during maintenance BCG, and repeat GA cystoscopies with four quadrant bladder biopsies routinely obtained following the completion of induction and maintenance treatment. Results: For patients undergoing Fremantle protocol BCG, 98.8% (82/83) and 75.9% (63/83) of patients completed their induction and maintenance courses of BCG, respectively. Induction BCG was delivered over a median duration of 35 days (range 34–84 days), and maintenance BCG was delivered over a median duration of 266 days (range 1–682 days). The tumor recurrence rate was 10.8% (9/83) at the time of post‐induction biopsies, 2.4% (2/83) during maintenance treatment, 0% (0/60) at the time of post‐maintenance biopsies, and 8.8% (5/57) after a median further follow‐up of 16 months (range 0–51 months). Conclusion: The Fremantle protocol appears to be a safe and effective BCG regimen with several advantages over other BCG protocols, including high completion rates, low recurrence rates, and being highly pragmatic.
- Subjects
FREMANTLE (W.A.); WESTERN Australia; INTRAVESICAL administration; BLADDER cancer; TREATMENT effectiveness; NON-muscle invasive bladder cancer; BCG immunotherapy; MEDICAL protocols; DISEASE relapse
- Publication
Asia Pacific Journal of Clinical Oncology, 2023, Vol 19, Issue 6, p697
- ISSN
1743-7555
- Publication type
Article
- DOI
10.1111/ajco.13933