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Second-line intravesical therapy versus cystectomy for bacille Calmette-Guérin (BCG) failures
Fadi N Joudi1, Michael A O'Donnell
1Department of Urology, University of Iowa, Iowa City, 200 Hawkins Drive, IA 52242, USA.
Purpose Of Review:
To give an update on the new modalities in treating patients with superficial bladder cancer who have failed bacille Calmette-Guérin.
Recent Findings:
The addition of interferon to bacille Calmette-Guérin has proven to be an effective combination therapy for bacille Calmette-Guérin failures. Electromotive intravesical mitomycin C as well as local microwave hyperthermia have been shown to improve drug delivery and increase response rates. Intravesical gemcitabine has shown some promising results in phase I studies and is being investigated in phase II trials. Photodynamic therapy is proposed as a second-line therapy for bacille Calmette-Guérin failures.
Summary:
New treatment modalities are being introduced and existing ones improved to treat bacille Calmette-Guérin-refractory superficial bladder cancer. These agents need to be studied in large randomized trials. Until these agents prove to decrease recurrence rates and delay progression of high-risk superficial bladder cancer, cystectomy remains the standard of care for the patient who is a good surgical candidate and willing to undergo such major surgery.