Buenos Aires, Argentina (UroToday.com) Yves Fradet, Professor University of Laval, discussed definitions of BCG failure including refractory, relapsing and intolerant BCG failures. Not all BCG strains are equivalent and need to be taken into consideration.
BCG vs BCG/IFN randomized trial was negative, however, 45% prior BCG failures were responsive to BCG/IFN combination therapy. Additional immunotherapy combinations are being considered including anti-PDL-1, anti-PD1 and anti-CTLA4 immune checkpoint inhibitors. These inhibitors have been successful with even complete response in patients with metastatic bladder cancer with or without prior chemotherapy treatment. Electromotive MMC has been shown to have decreased progression with improved survival when combined with BCG vs. BCG alone. Concentration of MC, alkalization and ensuring bladder empty prior to instillation will optimize MMC delivery with improved oncologic efficacy. MMC hyperthermia are other alternatives to enhance delivery of MMC with results pending.
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.