Evaluation of the Side Effect Profile of Intracavitary Bacillus Calmette-Guerin Treatment in Non-muscle-invasive Bladder Cancer

Objective: To reveal the association of side effect profiles seen in patients receiving intravesical bacillus Calmette-Guerin (BCG) immunotherapy for non-muscle-invasive bladder cancer (NMIBC) treatment with patient age and possible changes over time due to the use of different BCG strains. Materials and Methods: We retrospectively analyzed the medical records of all patients who received BCG for NMIBC in our hospital between January 2013 and December 2017. Investigated parameters included patients' demographics, treatment dates, local and systemic side effects (dysuria, hematuria, cystitis, headache, arthralgia/myalgia, chills, fever, fatigue, epididymo-orchitis, renal abscess, pneumonia, hepatitis, and sepsis), need for hospitalization and antituberculous therapy, discontinuation of therapy, and doses received. Results: The study included 89 patients (84 male, 5 female) with a mean age of 67.4 +/- 10.2 years. The most common side effects were dysuria (41.6%), chills (31.5%), hematuria (30.3%), fever (29.2%), cystitis (24.7%), and fatigue (23.6%). Ten patients (11.2%) were hospitalized due to treatment-related side effects. Ten patients discontinued treatment due to side effects. Sixty-two patients (69.7%) experienced at least 1 local or systemic side effect. There was no significant difference between patients younger and older than 70 years in terms of side effect rates (69.8% vs 69.4%, p=0.576). In addition, a significant difference was not observed in complication rates when we compared treatment before and after 2016 (65.3% vs 75%, p=0.322). Conclusion: Intracavitary BCG can be the treatment of choice in NMIBC even in patients at an advanced age. The absence of a significant change in complication rates over the years despite changing strains may be evidence that strains have a similar side effect profile.