Bladder Cancer Academy 2017: Intravesical Therapy: When Bacillus Calmette-Guerin Fails

Schaumburg, IL ( Dr. Hahn gave an update on intravesical therapies in bladder cancer. A myriad of studies exist on Bacillus Calmette-Guerin (BCG) therapy and the recurrence rates in non-muscle-invasive bladder cancer (NMIBC) patients. These trials have shown a 3 month complete response (CR) ranging from 18-79% and a 1 year recurrence-free survival (RFS) ranging from 10-75%. 

Modern BCG terminology includes “BCG unresponsive” (any of the following):
  • Recurrent/persistent disease after completion of at least induction (5/6 instillations) and at least 2/3 maintenance instillations (5+2) for Ta/T1 HG or CIS disease. 
  • The patient should never have reached complete response or has recurred within 6 months of last BCG instillation
  • T1 HG disease at first evaluation after induction BCG (5/6 instillations)
  • Prostatic urethra involvement
Another newly defined term is “BCG relapsing” – all patients not BCG-naïve that do not fulfill BCG unresponsive criteria.

Other intravesical agents have been studied in the past, showing some promising results, including Gemcitabine, Valrubicin and Docetaxel (in combination with Gemcitabine). Currently, there are several trials assessing new intravesical agents including nanoparticle albumin bound Paclitaxel, Oportuzumab Monatox,Nadofaragene firadenovec (Adstiladrin®), BC-819 and more.

Summarizing his talk, Dr. Hahn stated that BCG was the first successful immunotherapy discovered. Defining BCG unresponsive patients has invigorated clinical trial options, and greater understanding of tumor biology, immunology, and delivery technologies have expanded therapeutic approaches. Lastly, Dr. Hahn emphasized that engaging urologist in clinical trials is critical to future progress in general and in this field in particular.

Presented By: Noah Hahn, MD, James Buchanan Brady Urologic Institute, Johns Hopkins Medical Institutions

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, Twitter: @GoldbergHanan, at the 2017 Bladder Cancer Academy - June 9 - 10 - Schaumburg, Illinois, USA.