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Cystectomy remains the standard option for patients with BCG

[ScienceFirst]

 

 

Note also this:

 

• BCG intolerance: severe side effectsthat prevent further BCG instillation

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• BCG-unresponsive tumor: comprises BCG-refractory and early BCG-relapsing tumor, i.e., within 6 months for HG papillary tumors and within 12 months for CIS.  This last category is the largest among patients with NMIBC in whom further BCG therapy is not recommended. It constitutes a challenge for the practicing urologist. The optimal management of these patients is still controversial

Cystectomy remains the standard option for patients with BCG-unresponsive NMIBC following adequate BCG treatment

No established and effective intravesical therapies are available for patients whose tumors recur after BCG, representing a clinically important unmet need. Radical cystectomy (RC) provides cancer eradication in a significant number of HG NMIBC cases [11]. In the series of Stein and coworkers [12], the 10-year recurrence-free survival for patients with lymph node-negative tumors was 86% for T0, 89% for Tis, 74% for Ta, and 78% for T1 tumors. Several studies since have shown the advantage of performing early cystectomy in high-risk NMIBC patients, particularly in the case of BCG failure. It remains the standard of care in the case of BCG-unresponsive patients following adequate BCG treatment [6, 7].

However many patients are elderly, have significant comorbidities with a diminished performance status, and/or are unwilling to undergo radical extirpative surgery.

Source:  BCG-unresponsive high-grade non-muscle invasive bladder cancer: what does the practicing urologist need to know?