Approach to address the Shortage of BCG -InterestingWonder if they have heard of Urocidin or Bioniche???
https://bladdercancercanada.org/en/news/approach-for-consideration-to-address-shortage-of-bacillus-calmette-guerin
posted on September 11
TO: Physicians Prescribing Treatment for Non-muscle Invasive Bladder Cancer
RE: Approach for Consideration to Address Shortage of Bacillus Calmette-Guérin (BCG)
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As many of you are aware, there is a shortage of Bacillus Calmette-Guérin (BCG) across North America. Most hospitals will likely run out of BCG within the next 1-3 weeks. In the meantime, there are bladder cancer patients that require therapy. Below is a proposed approach for consideration to increase the pool of patients that can access BCG and provide alternatives if BCG is not available at all.
While the shortage of BCG is ongoing, the medical advisory board of Bladder Cancer Canada and the CUA guidelines committee have reviewed and support the following suggestions:
1. No patient receive maintenance BCG
2. All patients receive 1/3 dose of BCG (+/- interferon), instead of full dose BCG to triple the pool of pts that can get BCG
3. All patients with multirecurrent/multifocal low-grade Ta lesions receive mitomycin (or epirubicin) instead of BCG
4. Consideration for re-TUR in any patients with high grade Ta/T1 tumours
5. If BCG is not available at all in your center, preferred alternatives to BCG include electromotive mitomycin (EMDA-MMC) or sequential intravesical gemcitabine/docetaxel. Standard intravesical mitomycin (or epirubicin) may also be an option with limited benefit.
6. Consideration for upfront radical cystectomy as an option in patients with very high risk disease (T1HG with concomitant CIS) who are not willing to take any potential oncologic risks with alternative intravesical agents
Sincerely,
Wassim Kassouf, MD, CM, FRCSC
Chair, BCC Medical Advisory Board
VP Communications, Canadian Urological Association