Definition and management of patients with bladder cancer who fail BCG therapy.
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.
Martin
Frances M
FM
Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Kamat
Ashish M
AM
D000283:Administration, Intravesical; D001500:BCG Vaccine / Q000008:administration & dosage / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D015653:Cystectomy / Q000379:methods*; D016207:Cytokines / Q000008:administration & dosage / Q000378:metabolism; D006801:Humans; D012307:Risk Factors; D016879:Salvage Therapy / Q000379:methods; D013997:Time Factors; D017211:Treatment Failure; D001749:Urinary Bladder Neoplasms / Q000503:physiopathology / Q000628:therapy*
D001500:BCG Vaccine; D016207:Cytokines