Maintenance Bacillus Calmette-Guérin Therapy: The Search for the Optimum Treatment Schedule Continues

Reply from Author re: Richard J. Sylvester. Maintenance Bacillus Calmette-Guérin Therapy: The Search for the Optimum Treatment Schedule Continues. Eur Urol 2015;68:263–4

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We agree with the wise words of Sylvester [1] in response to our study [2]. We do need biomarkers to evaluate the immunologic response after bacillus Calmette-Gué rin (BCG) therapy to allow us to tailor, trim, and adapt the optimum dose and treatment schedule for each individual patient.

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Comparison of intravesical instillation of Bacille Calmette-Guérin and epirubicin: a randomized controlled trial

“…Six weeks inductive BCG instillations only are not enough for intermediate and high risk NMIBC treatment, and current evidences support 1-3 years maintenance schedule (14). A recent meta-analysis which included 1951 patients demonstrated that longer-maintenance therapy didn't increase side effect compared with induction therapy only, and longer maintenance (more than 1 years) wasn't superior to 1 years maintenance (15).…”

Paper Alert

“… Despite articles and studies to the contrary [ 1 ], three of the papers reviewed reported using different strains of BCG in similar populations (but distinctly different studies), with relatively similar results [ 2–4 ]. Aside from patients at highest risk for progression, the role of maintenance BCG, including optimal durations, doses, and schedules of treatments remain uncertain [ 5, 6 ]. While reduced doses of BCG (usually done to avoid toxicity but employed during the recent shortages to permit treating more patients) has not been found to be as effective as full dose in some studies [ 6 ], in others, as in Yokomizo et al’s, reviewed here, it is as effective [ 3 ].…”

“…Aside from patients at highest risk for progression, the role of maintenance BCG, including optimal durations, doses, and schedules of treatments remain uncertain [ 5, 6 ].…”