title: Bacillus calmette-guérin failures and beyond: contemporary management of non-muscle-invasive bladder cancer.
abstract: In the United States, bacillus Calmette-Guérin (BCG) is the treatment most used for superficial bladder cancer. Patients with carcinoma in situ (CIS) treated with intravesical BCG plus interferon have a 60% to 70% chance of a complete and durable response if they were never treated with BCG or if they failed only 1 prior induction or relapsed more than a year from induction. Intravesical gemcitabine is safe, but its usefulness for BCG-refractory patients is unclear. Valrubicin, approved for intravesical treatment of BCG-refractory CIS of the bladder, has efficacy and acceptable toxicity. Cystectomy should be considered in high-risk, non-muscle-invasive cancer, particularly if intravesical therapy failed.
authors.forename: H Barton
authors.initials: HB
authors.lastname: Grossman
authors.forename: Michael A
authors.initials: MA
authors.lastname: O'Donnell
authors.forename: Michael S
authors.initials: MS
authors.lastname: Cookson
authors.forename: Richard E
authors.initials: RE
authors.lastname: Greenberg
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Keane