title: Interferon alfa in the treatment paradigm for non-muscle-invasive bladder cancer.
abstract: OBJECTIVE
  In this article, we review the various options for and the potential role of interferon alfa (IFN-α) in the treatment of non-muscle-invasive bladder cancer (NMIBC).
  
  
  METHODS
  PubMed was searched for journal articles on IFN-α use in treating bladder cancer. The references listed in the National Comprehensive Cancer Network guidelines were used as a guide to identify relevant publications on treatments for NMIBC.
  
  
  RESULTS
  Transurethral resection with adjuvant intravesical chemotherapy or immunotherapy is the standard treatment option for NMIBC. Adjuvant IFN-α therapy has limited efficacy in preventing recurrences in intermediate-risk and high-risk patients; bacillus Calmette-Guérin (BCG) monotherapy is the recommended first-line treatment in these patients. Unfortunately, cancer progression or recurrence is a common outcome; radical cystectomy, which is often the lifesaving approach in such a scenario, is associated with significant morbidity, mortality, and decreased quality of life. Current alternatives to cystectomy include repeat intravesical immunotherapy, conventional instillation chemotherapy, and device-assisted intravesical chemotherapy. The efficacy of any chemotherapy after BCG failure, either conventional or device assisted, has not been established. BCG and IFN-α combination intravesical therapy has not been investigated thoroughly; based on available data, combination therapy appears to be most effective in patients with carcinoma in situ and may be preferentially considered as an alternative to radical cystectomy for patients with intermediate-risk or high-risk NMIBC who do not tolerate the standard BCG dose or experience BCG failure after 1 year of therapy. However, this approach requires close follow-up and should only be chosen after careful consideration of all risk factors.
  
  
  CONCLUSIONS
  There is a lack of efficacious treatment options for patients with NMIBC recurrence or progression after initial BCG treatment. There is a need for well-designed clinical trials investigating the safety and efficacy of available therapies, including BCG and IFN-α2b combination therapy.
authors.affiliation: BCG Oncology, P.C., Phoenix, AZ. Electronic address: dlamm@bcgoncology.com.
authors.forename: Donald
authors.initials: D
authors.lastname: Lamm
authors.affiliation: AUSL Modena, New S Agostino Hospital, Modena, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Brausi
authors.affiliation: University of Iowa Carver College of Medicine, Iowa City, IA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: O'Donnell
authors.affiliation: Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: J Alfred
authors.initials: JA
authors.lastname: Witjes
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use; D000283:Administration, Intravesical; D001500:BCG Vaccine / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D015653:Cystectomy; D018450:Disease Progression; D006801:Humans; D007167:Immunotherapy / Q000379:methods; D016898:Interferon-alpha / Q000627:therapeutic use*; D008495:Medical Oncology / Q000639:trends; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000276:immunology
chemical_list: D000276:Adjuvants, Immunologic; D001500:BCG Vaccine; D016898:Interferon-alpha
keywords: Bacillus Calmette-Guérin; Chemotherapy; Immunotherapy; Interferon alfa; Intravesical therapy; Non–muscle-invasive bladder cancer