Buenos Aires, Argentina (UroToday.com) Per-Uno Malstrom, Professor University of Uppsala, Sweden, discussed first the definitions of BCG failure then treatments. Refractory, relapsing and intolerant are appropriate definitions to use with patients who do not respond, respond but recur and cannot tolerate BCG treatments, respectively.
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With almost half of BCG treated patients failing we need improved treatments. Alternatives include cystectomy, chemotherapy or combinations and other immunotherapies. MMC after BCG does not have as marked an effect as treatment with MMC followed by BCG. Combinations have been considered with prior research with MMC/BCG vs. BCG with BCG alone superior to combination therapy regarding disease free survival. More recently, patients treated with BCG followed MMC the following day showing increased toxicity and decreased incidence of recurrent disease in the combination cohort. GC and MMC/docetaxel as salvage therapy have been explored with modest results. Electromotive drug administration MMC with BCG has decreased recurrence vs BCG alone but increased toxicity. Application of PDL-1 inhibitors are being evaluated in the context of NMIBC. Photodynamic therapy allows improved detection CIS and offer office laser ablation of these lesions. Trials are underway with results pending which will hopefully improve the type and delivery of these agents to decrease recurrence and progression of NMIBC.
World Urological Oncology Federation Symposium at the SIU Congress 2016 - October 20 - 23, 2016 – Buenos Aires, Argentina
Written By: Stephen B. Williams, M.D., Assistant Professor in Urology, The University of Texas Medical Branch, Galveston, TX. and Ashish Kamat, M.D. Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.