BCG vs TLD1433Even if BCG as reliable, its treatment is a long one. So we would still have an advantage, if all other things (efficacy %, etc ...) were equal.
Recently, standard guideline definitions were put out to decrease discrepancy in clinical trial design. These definitions are predicated on the receipt of adequate BCG and define a population that will not benefit from further BCG. Adequate BCG therapy is defined as at least 2 courses of BCG. This includes 5/6 induction doses plus at least 2/3 doses of maintenance therapy or at least 2/6 doses of a second induction therapy. Should BCG shortages necessitate dosing and schedule changes, these definitions may need to be adjusted. BCG-unresponsive disease refers to patients who have high-grade recurrence following adequate BCG therapy. The term encompasses both BCG refractory and BCG relapsing. Interestingly, Li et al. found that there is an inherent difference in prognostic implications for patients with BCGunresponsive disease. Comparing patients with recurrence after adequate BCG therapy to those with recurrence after only one induction course showed significantly lower cystectomyfree survival and rates of recurrent disease (77% vs 22% 5-year high grade recurrence) [35]. This elucidates the need for better alternatives for high-grade BCG-unresponsive disease.