Failure of bacille Calmette-Guérin in patients with high risk non-muscle-invasive bladder cancer unsuitable for radical cystectomy: an update of available treatment options.
Although the accepted standard upon failing intravesical bacille Calmette-Guérin (BCG) in patients with high-risk non-muscle-invasive bladder cancer (NMIBC) is radical cystectomy, there are some patients for whom this is not an option. We critically reviewed previous reports on the treatment possibilities available in such a clinical scenario. The options available can be categorized as chemotherapy, immunotherapy, device-assisted therapy and combined therapy. Combining new with established intravesical treatments seems to hold the most promise. Maintenance thermo-chemotherapy gives a reported 2-year disease-free survival rate of 50% and in small early-phase studies of intravesical gemcitabine administered in combination with mitomycin-C, tolerance and efficacy data would suggest the need for larger trials, given the early encouraging results. Electromotive mitomycin-C given sequentially with BCG might not only reduce the recurrence rate but also reduce progression and disease-specific mortality, although currently there is no trial in a specific population with 'BCG failure'.
Yates
David R
DR
Department of Urology, Royal Hallamshire Hospital, Sheffield, South Yorks, UK. d.yates@sheffield.ac.uk
Rouprêt
Morgan
M
D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000283:Administration, Intravesical; D001500:BCG Vaccine / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D015653:Cystectomy; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D007167:Immunotherapy; D016685:Mitomycin / Q000627:therapeutic use; D009361:Neoplasm Invasiveness; D012307:Risk Factors; D017211:Treatment Failure; D001749:Urinary Bladder Neoplasms / Q000628:therapy*; D000093542:Gemcitabine
D000276:Adjuvants, Immunologic; D001500:BCG Vaccine; D003841:Deoxycytidine; D016685:Mitomycin; D000093542:Gemcitabine