Second-line intravesical therapy versus cystectomy for bacille Calmette-Guérin (BCG) failures.
OBJECTIVE
To give an update on the new modalities in treating patients with superficial bladder cancer who have failed bacille Calmette-Guérin.


RESULTS
The addition of interferon to bacille Calmette-Guérin has proven to be an effective combination therapy for bacille Calmette-Guérin failures. Electromotive intravesical mitomycin C as well as local microwave hyperthermia have been shown to improve drug delivery and increase response rates. Intravesical gemcitabine has shown some promising results in phase I studies and is being investigated in phase II trials. Photodynamic therapy is proposed as a second-line therapy for bacille Calmette-Guérin failures.


CONCLUSIONS
New treatment modalities are being introduced and existing ones improved to treat bacille Calmette-Guérin-refractory superficial bladder cancer. These agents need to be studied in large randomized trials. Until these agents prove to decrease recurrence rates and delay progression of high-risk superficial bladder cancer, cystectomy remains the standard of care for the patient who is a good surgical candidate and willing to undergo such major surgery.
Department of Urology, University of Iowa, Iowa City, 200 Hawkins Drive, IA 52242, USA.
Fadi N
FN
Joudi
Michael A
MA
O'Donnell
D000276:Adjuvants, Immunologic / Q000008:administration & dosage*; D000283:Administration, Intravesical; D001500:BCG Vaccine / Q000008:administration & dosage*; D015653:Cystectomy; D006801:Humans; D010778:Photochemotherapy; D017211:Treatment Failure; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000601:surgery*
D000276:Adjuvants, Immunologic; D001500:BCG Vaccine