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BCG Treatment Response in Elderly Patients with Non-Muscle Invasive Bladder Cancer - Expert Commentary

Bacillus Calmette-Guerin (BCG) is a standard treatment for intermediate and high-risk non-muscle invasive bladder cancer (NMIBC). Given its immune-mediated effects, concerns exist as to whether age-related immune impairment might reduce its efficacy in older patients. A recent study by Tavelli et al. investigated whether patient age affects BCG treatment outcomes in NMIBC by analyzing 473 patients treated with adequate BCG between 2000 and 2023 at a single institution. Patients were divided into two cohorts: age ≤70 years (232 patients, 49%) and age >70 years (241 patients, 51%). These cohorts were compared for oncologic outcomes.

The study used the Fine-Gray competing risk survival analysis to assess outcomes while accounting for nonbladder cancer death as a competing risk. Patient demographics and tumor characteristics were similar between age groups, with no significant differences in sex, race, or tumor characteristics. In the competing risk analysis, age >70 was not significantly associated with increased high-grade recurrence (HR 0.77; 95% CI 0.59-1.02, P = 0.06), progression to muscle invasive disease or metastasis (HR 1.17; 95% CI 0.62-2.18, P = 0.63), or cancer-specific mortality (HR 1.12; 95% CI 0.42-2.95, P = 0.82). Multivariable analysis confirmed these findings, with age >70 showing no association with worse oncologic outcomes.

These results validate findings from other recent studies suggesting that BCG efficacy in NMIBC is not negatively affected by increased patient age. This contradicts some earlier studies. The findings suggest that chronological age alone should not influence treatment decisions regarding BCG therapy, as it remains effective in older patients with NMIBC. Additional studies to understand aging-related biological changes in response to newer intravesical therapies are warranted.

Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine

References:

  1. Tavelli JP, Chung R, Bai K, Gorroochurn P, Duong J, Anderson CB. The impact of age on BCG treatment response. Urol Oncol Semin Orig Investig. 2025; doi:10.1016/j.urolonc.2025.02.004
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