title: Expert consensus document: Consensus statement on best practice management regarding the use of intravesical immunotherapy with BCG for bladder cancer.
abstract: Multiple clinical trials have demonstrated that intravesical Bacillus Calmette-Guérin (BCG) treatment reduces recurrences and progression in patients with non-muscle-invasive bladder cancer (NMIBC). However, although BCG has been in use for almost 40 years, this agent is often underutilized and practice patterns of administration vary. This neglect is most likely caused by uncertainties about the optimal use of BCG, including unawareness of optimal treatment schedules and about patient populations that most benefit from BCG treatment. To address this deficit, a focus group of specialized urologic oncologists (urologists, medical oncologists and radiation oncologists) reviewed the current guidelines and clinical evidence, discussed their experiences and formed a consensus regarding the optimal use of BCG in the management of patients with NIMBC. The experts concluded that continuing therapy with 3-week BCG maintenance is superior to induction treatment only and is the single most important factor in improving outcomes in patients with NMIBC. They also concluded that a reliable alternative to radical cystectomy in truly BCG-refractory disease remains the subject of clinical trials. In addition, definitions for common terms of BCG failure, such as BCG-refractory and BCG-intolerant, have been formulated.
authors: The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1373, Houston, TX 77030, USA.
authors: Ashish M
authors: AM
authors: Kamat
authors: University of Colorado, MS 8117, 12801 E. 17th Avenue, Room 8117, Aurora, CO 80045, USA.
authors: Thomas W
authors: TW
authors: Flaig
authors: The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1373, Houston, TX 77030, USA.
authors: H Barton
authors: HB
authors: Grossman
authors: University of Minnesota, 420 Delaware Street Southeast, Minneapolis, MN 55455, USA.
authors: Badrinath
authors: B
authors: Konety
authors: BCG Oncology, 3815 East Bell Road, Suite 1210, Phoenix, AZ 85032, USA.
authors: Donald
authors: D
authors: Lamm
authors: University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA.
authors: Michael A
authors: MA
authors: O'Donnell
authors: University of California Irvine, 333 City Boulevard, Suite 2100, Orange, CA 92868, USA.
authors: Edward
authors: E
authors: Uchio
authors: Harvard Medical School, 100 Blossom Street, Cox 3, Boston, MA 02114, USA.
authors: Jason A
authors: JA
authors: Efstathiou
authors: University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA.
authors: John A
authors: JA
authors: Taylor
mesh_terms: D000283:Administration, Intravesical; D001500:BCG Vaccine / Q000627:therapeutic use*; D019985:Benchmarking; D003131:Combined Modality Therapy; D006801:Humans; D007167:Immunotherapy / Q000379:methods*; D008297:Male; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*
chemical_list: D001500:BCG Vaccine