, Volume 24, Issue 5, pp 481-487
Date: 22 Sep 2006

Treatment options for BCG failures

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Scope of the problem

Despite the significant activity of bacillus Calmette-Guerin (BCG) on superficial bladder cancer, most patients eventually relapse. Even in the case of carcinoma in situ (CIS), where BCG is the undisputed superior intravesical agent, after up to 2 cycles of BCG therapy only 46.7% of all patients are disease free at 3.6 years median follow-up [1]. In countries where BCG is used as the predominant first line agent even for papillary disease it is expected that the BCG failure population accumulates in the prevalence pool, accounting for at least an estimated 50,000 cases in the United States alone.

Need for clear definitions of BCG failure

Herr and Dalbagni aptly noted that comparisons between therapies for BCG failure patients have been hampered by the lack of standard definitions for BCG failure and BCG-refractory transitional cell carcinoma (TCC) [2]. Some series have defined BCG failure after a single induction course of BCG [3, 4], others after two cour ...