39P - The use of antibiotics or proton pump inhibitors and the response to intravesical Bacillus Calmette Guérin therapy in non-muscle-invasive bladder cancer

Background

Drugs with potential to disrupt the microbiome and therefore the immune system, such as antibiotics (ATB) and/or proton pump inhibitors (PPI), have been associated with a negative impact in several oncologic treatments. Here we aimed to evaluate the impact of ATB and PPI in the outcome of non-muscle-invasive bladder cancer (NMIBC) treated with intravesical Bacillus Calmette-Guérin (BCG).

Methods

We conducted a retrospective observational study including patients with NMIBC who underwent transurethral resection of a bladder tumor (TURBT), followed by intravesical BCG therapy, at our institution, between 2013 and 2018. We categorized patients as receiving ATB in the previous 2 months before BCG initiation and baseline use of PPI. Oncologic outcomes such as recurrence-free survival (RFS) and progression-free survival (PFS) were analyzed.

Results

Forty-nine patients were enrolled and their mean age was 67.2 years and 41 (83.7%) were males. Concerning NMIBC 16 (32.7%) had Ta disease while 33 (67.3%) had T1. Twenty-five (51.0%) patients took ATB prior to intravesical BCG therapy and 10 (20.4%) were taking PPI at baseline. During the follow-up period 15 (30.6%) patients had disease recurrence and 8 (16.3%) progression. Previous ATB intake was not associated with differences in RFS (3-year RFS: 79.8% with ATB vs 73.3% without; log rank, p=0.348) or PFS (3-year PFS: 87.8% with ATB vs 95.5% without; log rank, p=0.451). Concerning PPI intake, there were no significant differences in RFS, however there was a non-significant trend for worst outcome in those taking PPI at baseline (3-year RFS: 57.1% with PPI vs 81.5% without; log rank, p=0.083). Concerning PFS, there were no differences for PPI intake between the two groups (3-year PFS: 90.0% with PPI vs 92.1% without; log rank, p=0.118).

Conclusions

PPI or ATB intake was not associated with worst oncologic outcomes after intravesical BCG treatment. Further studies are needed to better understand the association between these drugs and NMIBC prognosis.

Editorial acknowledgement

Clinical trial identification

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.