Consensus statement on best practice management regarding the use of intravesical immunotherapy with BCG for bladder cancer

• Published in: Nature reviews. Urology Vol. 12; no. 4; pp. 225 - 235
• Main Authors: Kamat, Ashish M., Flaig, Thomas W., Grossman, H. Barton, Konety, Badrinath, Lamm, Donald, O'Donnell, Michael A., Uchio, Edward, Efstathiou, Jason A., Taylor, John A.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.04.2015; Nature Publishing Group
• Subjects: 692/4025/2768/589/1336; 692/700/565/1436; 692/700/565/251; BCG; BCG vaccines; Bladder cancer; Care and treatment; consensus-statement; Dosage and administration; Drug therapy; Evaluation; Immunotherapy; Medicine & Public Health; Methods; Practice guidelines (Medicine); Urology
• ISSN: 1759-4812; 1759-4820
• DOI: 10.1038/nrurol.2015.58

A focus group of specialized urologic oncologists has reviewed guidelines and clinical evidence and discussed their experiences regarding the optimal use of BCG in the management of patients with NIMBC. Here, they provide a review of BCG therapy, clarify complex related topics and recommend best practice guidelines to improve BCG use and patient outcomes. Multiple clinical trials have demonstrated that intravesical Bacillus Calmette–Guérin (BCG) treatment reduces recurrences and progression in patients with non-muscle-invasive bladder cancer (NMIBC). However, although BCG has been in use for almost 40 years, this agent is often underutilized and practice patterns of administration vary. This neglect is most likely caused by uncertainties about the optimal use of BCG, including unawareness of optimal treatment schedules and about patient populations that most benefit from BCG treatment. To address this deficit, a focus group of specialized urologic oncologists (urologists, medical oncologists and radiation oncologists) reviewed the current guidelines and clinical evidence, discussed their experiences and formed a consensus regarding the optimal use of BCG in the management of patients with NIMBC. The experts concluded that continuing therapy with 3-week BCG maintenance is superior to induction treatment only and is the single most important factor in improving outcomes in patients with NMIBC. They also concluded that a reliable alternative to radical cystectomy in truly BCG-refractory disease remains the subject of clinical trials. In addition, definitions for common terms of BCG failure, such as BCG-refractory and BCG-intolerant, have been formulated.