A shortage of BCG is foreseen till the end of 2013.
Which will be the management of intermediate and high-risk NMI-BC if BCG will not be available? In patients harboring high-risk NMI tumors, particularly T1G3 and Tis, the first therapeutic choice is radical cystectomy. Device-assisted therapies, although showing promising results, should be considered only for selected patients.
In intermediate risk patients, intravesical chemotherapy remains a legitimate option even if BCG is available. Thus, in a period of BCG shortage, intravesical chemotherapy should be offered, preferably preceded by early instillation, according to the EAU guidelines.
OddensJ., BrausiM., SylvesterR., BonoA., van de BeekC., van AndelG., GonteroP., HoeltlW., TurkeriL., MarreaudS., ColletteS., OosterlinckW.Final Results of an EORTC-GU Cancers Group Randomized Study of Maintenance Bacillus Calmette-Guérin in Intermediate- and High-risk Ta, T1 Papillary Carcinoma of the Urinary Bladder: One-third Dose Versus Full Dose and 1 Year Versus 3 Years of MaintenanceEur Urol.2012 Nov 2. doi: pii: S0302-2838(12)01270-5.10.1016.
2.
SylvesterR.J., BrausiM.A., KirkelsW.J.. Long-Term Efficacy Results of EORTC Genito-Urinary Group Randomized Phase 3 Study 30911 Comparing Intravesical Instillations of Epirubicin, Bacillus Calmette-Guérin, and Bacillus Calmette-Guérin plus Isoniazid in Patients with Intermediate- and High-Risk Stage Ta T1 Urothelial Carcinoma of the Bladder. Eur. Urol2010; 57: 677–773.
HerrH.W., DonatSM, DalbagniG.Can restaging transurethral resection of T1 bladder cancer select patients for immediate cystectomy?J Urol.2007; 177: 75.
5.
DenzingerS., FritscheH.S., OttoW., BlanaA., WielandW.F., BurgerM.Early versus deferred cystectomy for initial high-risk pT1G3 urothelial carcinoma of the bladder: do risk factors define feasibility of bladder-sparing approach?Eur Urol53: 146; 2008.
6.
PawinskiA., SylvesterR., KurthK.H., BouffiouxC., van der MeijdenA., ParmarM.K.B., BijnensL.A combined analysis of EORTC and MRC clinical trials for the prophylactic treatment of stage Ta T1 bladder cancer. J. Urol.1996, 156: 1934–40.
7.
HuncharekM., GeschwindJ.F., WhiterspoonB., Mc GarryR., AdcockD.Intravesical chemotherapy prophylaxis in primary superficial bladder cancer: a meta-analysis of 3703 patients from 11 randomized trials. J.Clin. Epid.2000, 53: 676–680.
8.
SylvesterR.J., OosterlinckW., van der MeijdenA.P.M.A single immediate postoperative instillation of chemotherapy decreases the risk of recurrence in patients with stage Ta T1 bladder cancer: a meta-analysis of published results of randomized clinical trials J. Urol.2004; 171: 2186–2190.
9.
KogaH., KuroiwaK., YamaguchiA., OsadaY., TsuneyoshiM., NaitoS.A randomized controlled trial of short-term versus long-term prophylactic intravesical instillation chemotherapy for recurrence after transurethral resection of Ta/T1 transitional cell carcinoma of the bladder. J Urol.2004; 171: 153–157.
10.
FriedrichM.G., PichlmeierU., SchwaiboldH., ConradS., HulandH.Long-term intravesical adjuvant chemotherapy further reduces recurrence rate compared with short-term intravesical chemotherapy and short-term therapy with Bacillus Calmette-Guérin (BCG) in patients with non-muscle-invasive bladder carcinoma. Eur Urol.2007; 52: 1123–29.
11.
BohleA., BockP.R.Intravesical bacille calmette-guerin versus mitomycin c in superficial bladder cancer: formal meta-analysis of comparative studies on tumor progressionUrol2004; 63: 682–687.
12.
Huncharek, KupelnickB.Impact of intravesical chemotherapy versus BCG immunotherapy on recurrence of superficial transitional cell carcinoma of the bladder. Am J Clin Oncol2003; 26: 402–407.
13.
MalmstromP-U, SylvesterR.J., CrawfordD.E.. An individual patient data meta-analysis of the long-term outcome of randomised studies comparing intravesical mitomycin C versus bacillus Calmette-Guerin for non-muscle-invasive bladder cancer. Eur Urol2009; 56: 247–56.
14.
SylvesterR.J.Bacillus Calmette-Guerin versus mitomycin C for the treatment of intermediate risk non-muscle-invasive bladder cancer: the debate continues. Eur Urol2009; 56: 266–8.
15.
DalbagniG.Is intravesical bacillus Calmette-Guerin better than mitomycin for intermediate-risk bladder cancer?Eur Urol2009; 56: 257–8.
