title: Contemporary management of patients with high-risk non-muscle-invasive bladder cancer who fail intravesical BCG therapy.
abstract: It is advocated that patients with high-risk non-muscle-invasive bladder cancer (NMIBC) receive an adjuvant course of intravesical Bacille Calmette-Guerin (BCG) as first-line treatment. However, a substantial proportion of patients will 'fail' BCG, either early with persistent (refractory) disease or recur late after a long disease-free interval (relapsing). Guideline recommendation in the 'refractory' setting is radical cystectomy, but there are situations when extirpative surgery is not feasible due to competing co-morbidity, a patient's desire for bladder preservation or reluctance to undergo surgery. In this review, we discuss the contemporary management of NMIBC in patients who have failed prior BCG and are not suitable for radical surgery and highlight the potential options available. These options can be categorised as immunotherapy, chemotherapy, device-assisted therapy and combination therapy. However, the current data are still inadequate to formulate definitive recommendations, and data from ongoing trials and maturing studies will give us an insight into whether there is a realistic efficacious second-line treatment for patients who fail intravesical BCG but are not candidates for definitive surgery.
authors.affiliation: Academic Department of Urology of la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, University Paris VI, Faculte de Medicine Pierre et Marie Curie and CeRePP, Centre d'Etudes et de Recherche sur les Pathologies Prostatiques, 47-83 Boulevard de l'Hopital, 75013, Paris, France.
authors.forename: D R
authors.initials: DR
authors.lastname: Yates
authors.forename: M
authors.initials: M
authors.lastname: Rouprêt
mesh_terms: D000283:Administration, Intravesical; D001500:BCG Vaccine / Q000008:administration & dosage / Q000627:therapeutic use*; D019468:Disease Management; D004358:Drug Therapy; D006801:Humans; D007167:Immunotherapy; D010778:Photochemotherapy; D016879:Salvage Therapy / Q000379:methods*; D017211:Treatment Failure; D001749:Urinary Bladder Neoplasms / Q000628:therapy*
chemical_list: D001500:BCG Vaccine