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NMIBC—BCG Refractory Disease and Use of Interferon

  • Sanchia S. GoonewardeneEmail author
  • Raj Persad
  • Hanif Motiwala
  • David Albala
Chapter

Abstract

Thirty to forty percent of patients with high grade nonmuscle invasive bladder cancer (NMIBC) fail to respond to intravesical therapy with bacillus Calmette-Guerin (BCG). Interferon-α2B plus BCG has been shown to be effective in a subset of patients with NMIBC BCG refractory disease (Correa et al. in Adv Urol 2015:656918, 2015). This chapter covers BCG refractory disease and use of interferon.

Thirty to forty percent of patients with high grade nonmuscle invasive bladder cancer (NMIBC) fail to respond to intravesical therapy with bacillus Calmette-Guerin (BCG). Interferon-α2B plus BCG has been shown to be effective in a subset of patients with NMIBC BCG refractory disease (Correa et al. 2015). Correa et al. (2015) reviewed a contemporary series on the effectiveness and safety of intravesical BCG plus interferon-α2B therapy in patients with BCG refractory NMIBC. High risk disease was found in 88.6% of patients at induction. The 12-month and 24-month recurrence-free survival were 38.6% and 18.2%, respectively. 25 (56.8%) ultimately had disease recurrence. Radical cystectomy was performed in 16 (36.4%) patients.

It is advocated that patients with high-risk non-muscle-invasive bladder cancer (NMIBC) receive an adjuvant course of intravesical Bacille Calmette-Guerin (BCG) as first-line treatment (Yates and Rouprêt 2011). However, a substantial proportion of patients will ‘fail’ BCG, either early with persistent (refractory) disease or recur late after a long disease-free interval (relapsing) (Yates and Rouprêt 2011). Guideline recommendation in the ‘refractory’ setting is radical cystectomy, but there are situations when extirpative surgery is not feasible due to competing co-morbidity, a patient’s desire for bladder preservation or reluctance to undergo surgery. These options can be categorised as immunotherapy, chemotherapy, device-assisted therapy and combination therapy (Yates and Rouprêt 2011). However, data is lacking from trials.

References

  1. Correa AF, Theisen K, Ferroni M, Maranchie JK, Hrebinko R, Davies BJ, Gingrich JR. The role of interferon in the management of BCG refractory nonmuscle invasive bladder cancer. Adv Urol. 2015;2015:656918.CrossRefGoogle Scholar
  2. Yates DR, Rouprêt M. Contemporary management of patients with high-risk non-muscle-invasive bladder cancer who fail intravesical BCG therapy. World J Urol. 2011;29(4):415–22.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Sanchia S. Goonewardene
    • 1
    Email author
  • Raj Persad
    • 2
  • Hanif Motiwala
    • 3
  • David Albala
    • 4
  1. 1.East of England DeaneryNorfolk and Norwich University HospitalNorwichUK
  2. 2.North Bristol NHS TrustBristolUK
  3. 3.Southend University HospitalWestcliff-on-SeaUK
  4. 4.Boston UniversityBostonUSA

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