[Recurrence and progression after BCG.]

Area of Science:

• Urology
• Oncology
• Immunotherapy

Background:

• Bacillus Calmette-Guérin (BCG) is the standard treatment for intermediate and high-risk non-invasive bladder tumors.
• Despite BCG treatment, recurrence rates can reach 30% and progression rates 10% within two years in high-risk patients.
• Limited bladder-preserving options exist post-BCG failure, often necessitating radical cystectomy.

Purpose of the Study:

• To define critical situations encountered during BCG treatment for non-invasive bladder cancer.
• To review essential aspects of BCG management in clinical practice and clinical trials.
• To highlight the importance of understanding BCG treatment nuances for optimizing patient outcomes.

Main Methods:

• Review of current literature and clinical guidelines on BCG immunotherapy for non-invasive bladder cancer.
• Analysis of recurrence and progression rates in patients treated with BCG.
• Discussion of emerging treatments, such as checkpoint inhibitors (PD1, PDL-1), for BCG non-responders.

Main Results:

• BCG failure can lead to tumor recurrence or progression, impacting oncological outcomes.
• Management strategies for critical situations during BCG therapy require clear definitions.
• Checkpoint inhibitors show promise for patients who do not respond to BCG.

Conclusions:

• Effective management of critical situations in BCG therapy is essential for patient care.
• Standardized definitions and approaches are needed for BCG treatment protocols and clinical trials.
• Further research into novel therapies is crucial for patients with BCG-refractory bladder cancer.