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.

The role of neutrophil to lymphocyte ratio in patients with pTa non-muscle invasive bladder cancer

“…In terms of survival, the five-year overall survival (OS) rate reaches up to 88% (5,6). In high-risk NMIBC, the rate of five-year recurrence reaches 80%, and progression can occur in up to 50% of all patients (7)(8)(9). These statistics make it one of the most costly cancers due to the lengthy follow-up procedures (5).…”

Current clinical trials in non–muscle invasive bladder cancer

“…[4] Given current therapies for bladder cancer have high rates of progression and recurrence, definitive therapy requires drastic change in quality of life, and the future potential for a BCG shortage, there are several reasons to urgently pursue new therapies in NMIBC patients. [5] Here we present a review of current or recently completed trials in NMIBC highlighting the many strategies being used to treat bladder cancer in both BCG naïve patients and patients who fail BCG.…”

The impact of the global bacille Calmette–Guérin shortage on treatment patterns: population‐based data

“…At the time of the shortage, the European Association of Urology (EAU) released a press release suggested continuing BCG therapy or replacing with intravesical chemotherapeutic agents for up to 12 months [5]. Similarly, Veeratterapillay et al [2] published recommendations during the BCG shortage, suggesting either: one-third dose BCG for induction and maintenance for 1 year, induction and maintenance with mitomycin C or gemcitabine, intravesical chemotherapy with thermotherapy or primary radical cystectomy. Despite these recommendations during the shortage, the resumption of production and improved availability of BCG would have intuitively resulted in the increased prescription of BCG for CIS.…”

“….surgery or chemotherapy that would result in infertility, and who cannot produce sufficient sperm for storage'. Cases commissioned for SSR must have '..a reasonable likelihood of successful retrieval of motile sperm' and 'confirmed funding for subsequent stages of the pathway (cryopreservation and/or IVF treatment)' [2].…”