The management of BCG failure in non-muscle-invasive bladder cancer: an update

Authors

  • Alexandre R. Zlotta Department of Surgery, Division of Urology, University of Toronto; Department of Surgery (Urology), Mount Sinai Hospital; Department of Surgical Oncology, University Health Network, Toronto, ON
  • Neil E. Fleshner Department of Surgery, Division of Urology, University of Toronto; Department of Surgical Oncology, University Health Network, Toronto, ON
  • Michael A. Jewett Department of Surgery, Division of Urology, University of Toronto; Department of Surgical Oncology, University Health Network, Toronto, ON

DOI:

https://doi.org/10.5489/cuaj.1196

Abstract

Up to 40% of patients with non-muscle-invasive bladder cancer
(NMIBC) will fail intravesical bacillus Calmette-Guérin (BCG)
therapy. There is unfortunately no current gold standard for salvage
intravesical therapy after appropriate BCG treatment. Indeed,
outcomes are at best suboptimal. The vast majority of low-grade
NMIBC are prone to recur but very rarely progress. Failure after
intravesical BCG in these patients is usually superficial and lowgrade.
At the other end of the spectrum, failure to respond to BCG
in high-risk T1 bladder cancer and/or carcinoma in situ (CIS or
TIS) is more problematic, since those tumours often have the potential
to progress to muscle invasion. In these cases, radical cystectomy
remains the mainstay after BCG failure. With appropriate
selection, certain patients who “fail” BCG (but with favourable
risk factors) can be managed with intravesical regimens, including
repeated BCG, BCG plus cytokines, intravesical chemotherapy,
thermochemotherapy or new immunotherapeutic modalities. In
this review, reasons explaining BCG failure, how to define BCG
failure, optimal risk stratification and prediction of response and
management of BCG failures are discussed.

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Author Biographies

Alexandre R. Zlotta, Department of Surgery, Division of Urology, University of Toronto; Department of Surgery (Urology), Mount Sinai Hospital; Department of Surgical Oncology, University Health Network, Toronto, ON

Neil E. Fleshner, Department of Surgery, Division of Urology, University of Toronto; Department of Surgical Oncology, University Health Network, Toronto, ON

Michael A. Jewett, Department of Surgery, Division of Urology, University of Toronto; Department of Surgical Oncology, University Health Network, Toronto, ON

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How to Cite

Zlotta, A. R., Fleshner, N. E., & Jewett, M. A. (2013). The management of BCG failure in non-muscle-invasive bladder cancer: an update. Canadian Urological Association Journal, 3(6-S4), S199-S205. https://doi.org/10.5489/cuaj.1196

Issue

Vol. 3 No. 6-S4 (2009): CUAJ December Suppl 4

Section

Review

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