Bacille-Calmette-Guerin Non-Responders: How to Manage
Bacille-Calmette-Guerin Non-Responders: How to Manage
BCG failure is one of the most complex and challenging scenarios in urologic oncology. It is imperative for the clinician to have a clear understanding of the indications for BCG treatment and the definition of BCG failure. The utilization of drug combinations and device-assisted treatments has the potential to improve treatment response. Inhibition of immune checkpoints and targeted therapy addressing central pathways of cell regulation are the subject of multiple clinical trials and could help to define new treatment algorithms. Patients who have failed BCG treatment are at a high risk for disease progression and a definitive treatment with cystectomy should be offered. The hopefully transient shortage of BCG may become a recurring problem in the future. It is imperative for any urologist to be aware of the potential alternatives and their limitations.
Conclusions
BCG failure is one of the most complex and challenging scenarios in urologic oncology. It is imperative for the clinician to have a clear understanding of the indications for BCG treatment and the definition of BCG failure. The utilization of drug combinations and device-assisted treatments has the potential to improve treatment response. Inhibition of immune checkpoints and targeted therapy addressing central pathways of cell regulation are the subject of multiple clinical trials and could help to define new treatment algorithms. Patients who have failed BCG treatment are at a high risk for disease progression and a definitive treatment with cystectomy should be offered. The hopefully transient shortage of BCG may become a recurring problem in the future. It is imperative for any urologist to be aware of the potential alternatives and their limitations.
