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67th Annual Meeting Abstracts
The Impact of Fibrin Clot Inhibitor Medications on the Efficacy of Bacillus Calmette-Guerin Therapy for Urothelial Carcinoma of the Bladder
*Stephen A Boorjian1, *Ryan K Berglund2, *Alexandra C Maschino2, *Caroline J Savage2, *Harry W Herr2
1Fox Chase Cancer Center, Rockledge, PA;2Memorial Sloan-Kettering Cancer Center, New York, NY
Introduction:
Studies have suggested that the antitumor effect of BCG is dependent upon attachment of BCG to fibronectin at sites of fibrin clot formation, and that medications which impact fibrin clot formation may modify BCG activity. We evaluated the impact of fibrin-clot inhibitors on the clinical efficacy of BCG.
Materials & Methods:
We reviewed 907 consecutive patients treated with BCG between 1990-2006. Time to disease recurrence and progression to surgery were compared for patients taking and not taking fibrin-clot inhibitors by Kaplan-Meier methods and multivariate Cox regression models.
Results:
Overall, 221 (24%) patients were taking at least one fibrin-clot inhibitor, including 170, 34, and 52 patients taking aspirin, clopidogrel, and warfarin, respectively. Patients taking warfarin had a shorter time to progression than patients not taking warfarin (median 2.1 vs 9.0 years,p<0.005), while patients taking aspirin had a significantly improved 5-year probability of freedom from surgery (66% vs 56%,p=0.029). On multivariate analysis, warfarin use was associated with an increased risk of progression to surgery (HR 1.89;95% CI 1.31, 2.74;p=0.0007), and aspirin use was associated with a decreased risk (HR 0.71;95% CI 0.52, 0.96;p=0.024). Use of warfarin alone was associated with an increased risk of tumor recurrence (HR 1.39;95% CI 1.00, 1.94;p=0.048).
Conclusions:
These data suggest that the risks of recurrence and progression to surgery following BCG are higher in patients taking warfarin, while the risk of progression is lower in patients on aspirin. These findings may have important implications for the management of such patients in whom BCG is being contemplated.
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