What to do during Bacillus Calmette–Guérin shortage? Valid strategies based on evidence. Issue 6 (November 2018)

• Record Type: Journal Article
• Authors: Abufaraj, Mohammad; Mostafid, Hugh; Shariat, Shahrokh F.; Babjuk, Marek
• Is Part Of: Current opinion in urology. Volume 28:Issue 6(2018:Nov.)
• Publication Date: 2018-11
• Subjects: Bacillus Calmette–Guérin -- Bacillus Calmette–Guérin shortage -- gemcitabine -- intravesical therapy -- mitomycin C -- nonmuscle invasive bladder cancer; Urology -- Periodicals; Review Literature -- Bibliography; Review Literature -- Periodicals; Male Urogenital Diseases -- Bibliography; Male Urogenital Diseases -- Periodicals; Female Urogenital Diseases -- Bibliography; Female Urogenital Diseases -- Periodicals; Urologic Diseases -- Bibliography; Urologic Diseases -- Periodicals; Periodicals; 616.6005
• DOI: 10.1097/MOU.0000000000000544
• Languages: English
• ISSNs: 1473-6586

Abstract

Abstract : Purpose of review: Over the last decade, the world has experienced health-threatening supply shortages of Bacillus Calmette–Guérin (BCG) immunotherapy for nonmuscle-invasive bladder cancer (NMIBC). We summarize the current literature to assist in treatment decisions in light of suboptimal supply. Recent findings: Currently available data do not support a superiority of one BCG strain over the other. Intravesical chemotherapy seems to provide similar results in term of disease progression but not recurrence in intermediate-risk patients. One trial has shown that a 3-year maintenance course of BCG in high-risk NMIBC has no advantage in term of progression or overall survival in comparison with 1-year maintenance. Synergo radiofrequency-induced hyperthermia is a reliable alternative in intermediate or high-risk NMIBC with at least similar recurrence rates compared with BCG. Summary: Patients with intermediate-risk NMIBC can be offered multiple instillations of intravesical chemotherapy for up to 12 months. In high-risk patients and in case of BCG shortage, BCG instillations can be terminated when the patient has completed 1 year of maintenance. Mitomycin C is an alternative in lowest risk high-risk (G3Ta) NMIBC, whereas patients with pT1/carcinoma in situ can be offered Synergo with mitomycin C when radical cystectomy is not feasible. Immediate radical cystectomy should always be considered in highest risk NMIBC after weighing up benefit to risk.