title: High-Risk Non-Muscle-Invasive Bladder Cancer-Therapy Options During Intravesical BCG Shortage.
abstract: Bladder cancer is the second commonest urinary tract malignancy with 70-80 % being non-muscle invasive (NMIBC) at diagnosis. Patients with high-risk NMIBC (T1/Tis, with high grade/G3, or CIS) represent a challenging group as they are at greater risk of recurrence and progression. Intravesical Bacilli Calmette-Guerin (BCG) is commonly used as first line therapy in this patient group but there is a current worldwide shortage. BCG has been shown to reduce recurrence in high-risk NMIBC and is more effective that other intravesical agents including mitomycin C, epirubicin, interferon-alpha and gemcitabine. Primary cystectomy offers a high change of cure in this cohort (80-90 %) and is a more radical treatment option which patients need to be counselled carefully about. Bladder thermotherapy and electromotive drug administration with mitomycin C are alternative therapies with promising short-term results although long-term follow-up data are lacking.
authors: Department of Urology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE77DN, UK.
authors: Rajan
authors: R
authors: Veeratterapillay
authors: Department of Urology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE77DN, UK. rakesh.heer@newcastle.ac.uk.
authors: Rakesh
authors: R
authors: Heer
authors: Department of Urology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE77DN, UK.
authors: Mark I
authors: MI
authors: Johnson
authors: Bristol Urology Institute, Southmead Hospital, Bristol, UK.
authors: Raj
authors: R
authors: Persad
authors: Department of Urology, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE77DN, UK.
authors: Christian
authors: C
authors: Bach
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D001500:BCG Vaccine; D015653:Cystectomy; D006801:Humans; D006979:Hyperthermia, Induced; D007167:Immunotherapy; D016685:Mitomycin / Q000627:therapeutic use; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents; D001500:BCG Vaccine; D016685:Mitomycin
keywords: Bacilli Calmette-Guerin; Bladder cancer; Intravesical Therapy; Mitomycin C; Surgery