Definition and management of patients with bladder cancer who fail BCG therapy

Abstract

Intravesical administration of bacillus Calmette–Guérin (BCG) following resection of non-muscle-invasive bladder tumor is the current ‘gold standard’. However, up to 40% of patients will fail therapy within the first year and response rates to salvage intravesical therapy after appropriate trial of BCG (i.e., after induction and one maintenance course) average 15–20% at 1 year. Radical cystectomy remains the only treatment with proven long-term benefit after BCG failure. Nonetheless, with appropriate selection, certain patients who ‘fail’ BCG (but have other favorable risk factors, e.g., a long interval between BCG and recurrence) can be managed with intravesical regimens including repeated BCG, BCG plus cytokines and/or intravesical chemotherapy. In this review, optimal risk stratification, appropriate definitions and management of BCG failures are discussed.

Keywords::

• bacillus Calmette–Guérin
• BCG failures
• bladder cancer
• intravesical therapy

Financial & competing interests disclosure

AM Kamat has received research support from Bioniche in the context of this review. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.