scholarly journals The Role of Interferon in the Management of BCG Refractory Nonmuscle Invasive Bladder Cancer

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Andres F. Correa ◽  
Katherine Theisen ◽  
Matthew Ferroni ◽  
Jodi K. Maranchie ◽  
Ronald Hrebinko ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Disease Recurrence ◽  
Invasive Bladder Cancer ◽  
Intravesical Therapy ◽  
Refractory Disease ◽  
Pathological Stage ◽  
Safe Alternative ◽  
Bcg Failure ◽  
Nonmuscle Invasive Bladder Cancer

Background. Thirty to forty percent of patients with high grade nonmuscle invasive bladder cancer (NMIBC) fail to respond to intravesical therapy with bacillus Calmette-Guerin (BCG). Interferon-α2B plus BCG has been shown to be effective in a subset of patients with NMIBC BCG refractory disease. Here we present a contemporary series on the effectiveness and safety of intravesical BCG plus interferon-α2B therapy in patients with BCG refractory NMIBC.Methods. From January of 2005 to April of 2014 we retrospectively found 44 patients who underwent induction with combination IFN/BCG for the management of BCG refractory NMIBC. A chart review was performed to assess initial pathological stage/grade, pathological stage/grade at the time of induction, time to IFN/BCG failure, pathological stage/grade at failure, postfailure therapy, and current disease state.Results. Of the 44 patients who met criteria for the analysis. High risk disease was found in 88.6% of patients at induction. The 12-month and 24-month recurrence-free survival were 38.6% and 18.2%, respectively. 25 (56.8%) ultimately had disease recurrence. Radical cystectomy was performed in 16 (36.4%) patients.Conclusion. Combination BCG plus interferon-α2B remains a reasonably safe alternative treatment for select patients with BCG refractory disease prior to proceeding to radical cystectomy.

scholarly journals Emerging intravesical therapies for the management of bacillus Calmette–Guérin (BCG)-unresponsive non-muscle-invasive bladder cancer: Charting a path forward

2020 ◽  
Vol 14 (6) ◽  
Author(s):  
Ali Cyrus Chehroudi ◽  
Peter C. Black
Keyword(s):  
Bladder Cancer ◽  
High Risk ◽  
Radical Cystectomy ◽  
Clinical Trial Design ◽  
Standard Of Care ◽  
Invasive Bladder Cancer ◽  
Intravesical Therapy ◽  
Muscle Invasive Bladder Cancer ◽  
Bcg Failure ◽  
Muscle Invasive

Management of patients with cacillus Calmette–Guérin (BCG)-unresponsive, high-risk, non-muscle-invasive bladder cancer (NMIBC) presents a formidable clinical challenge that requires urologists to weigh the competing risks of progression during further intravesical therapy vs. the morbidity of radical cystectomy. The prognosis of high-risk NMIBC recurring after BCG depends on the adequacy of prior BCG, the timing of recurrence, and tumor histology. The standard of care is currently radical cystectomy, as effective salvage intravesical therapy has not been established. The development of bladder-sparing treatments has been hampered to date by inconsistent definitions of BCG failure and difficulties in identifying appropriate control treatments in clinical trials. Despite these limitations, the spectrum of salvage therapy is expanding to include enhanced intravesical chemo-, gene, and immuno-therapies. In this review, we provide an overview of these emerging agents in the context of our current understanding of BCG failure and the unique considerations for clinical trial design in this disease state.

Nonmuscle-Invasive Bladder Cancer: What's Changing and What has Changed

2017 ◽  
Vol 84 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Ramanitharan Manikandan ◽  
Oscar Rodriguez ◽  
Rubén Parada ◽  
Joan Palou Redorta
Keyword(s):  
Bladder Cancer ◽  
Best Practice ◽  
Disease Recurrence ◽  
Invasive Bladder Cancer ◽  
Current Status ◽  
Optimal Care ◽  
Medline Search ◽  
Select Group ◽  
The Future ◽  
Nonmuscle Invasive Bladder Cancer

Purpose Nonmuscle-invasive bladder cancer (NMIBC) is a challenging disease to manage primarily due to its varied clinical course. The management of NMIBC has witnessed a widespread change with respect to its diagnosis and treatment. Although transurethral resection (TUR) and adjuvant bacillus Calmette–Guerin (BCG) stills remain the cornerstone, newer protocols has come into vogue to achieve optimal care. On the basis of a literature review, we aimed to establish ‘what changes has already occurred and what is expected in the future’ in NMIBC. Methods A Medline search was performed to identify the published literature with respect to diagnosis, treatment and future perspectives on NMIBC. Particular emphasis was directed to determinants such as the quality of TUR and the newer modifications, Re-TUR, current status of newer macroscopic and microscopic imaging, role of urinary biomarkers, clinical, histologic and molecular predictors of high-risk disease, administration of intravesical agents, salvage therapy in BCG recurrence and the current best practice guidelines were analyzed. Results and Conclusions Optimal TUR, restaging in select group, incorporation of newer endoscopic imaging and judicious administration of intravesical chemo-immunotherapeutic agents can contribute to better patient care. Although there is a plethora of urinary markers, there is insufficient evidence for their use in isolation. The future probably lies in identification of genetic markers to determine disease recurrence, nonresponders to standard treatment and early institution of alternative/targeted therapy.

scholarly journals Radical Cystectomy Against Intravesical BCG for High-Risk High-Grade Nonmuscle Invasive Bladder Cancer: Results From the Randomized Controlled BRAVO-Feasibility Study

2020 ◽  
pp. JCO.20.01665
Author(s):  
James W. F. Catto ◽  
Kathryn Gordon ◽  
Michelle Collinson ◽  
Heather Poad ◽  
Maureen Twiddy ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
High Risk ◽  
Radical Cystectomy ◽  
Controlled Trial ◽  
Invasive Bladder Cancer ◽  
High Grade ◽  
Bacillus Calmette Guerin ◽  
Randomized Controlled ◽  
Number Of Patients ◽  
Nonmuscle Invasive Bladder Cancer

PURPOSE High-grade nonmuscle invasive bladder cancer (HRNMIBC) is a heterogeneous disease. Treatments include intravesical maintenance Bacillus Calmette-Guerin (mBCG) and radical cystectomy (RC). We wanted to understand whether a randomized trial comparing these options was possible. MATERIALS AND METHODS We conducted a two-arm, prospective multicenter randomized study to determine the feasibility in Bacillus Calmette-Guerin-naive patients. Participants had new high-risk HRNMIBC suitable for both treatments. Random assignment was stratified by age, sex, center, stage, presence of carcinoma in situ, and prior low-risk bladder cancer. Qualitative work investigated how to maintain equipoise. The primary outcome was the number of patients screened, eligible, recruited, and randomly assigned. RESULTS We screened 407 patients, approached 185, and obtained consent from 51 (27.6%) patients. Of these, one did not proceed and therefore 50 were randomly assigned (1:1). In the mBCG arm, 23/25 (92.0%) patients received mBCG, four had nonmuscle invasive bladder cancer (NMIBC) after induction, three had NMIBC at 4 months, and four received RC. At closure, two patients had metastatic BC. In the RC arm, 20 (80.0%) participants received cystectomy, including five (25.0%) with no tumor, 13 (65.0%) with HRNMIBC, and two (10.0%) with muscle invasion in their specimen. At follow-up, all patients in the RC arm were free of disease. Adverse events were mostly mild and equally distributed (15/23 [65.2%] patients with mBCG and 13/20 [65.0%] patients with RC). The quality of life (QOL) of both arms was broadly similar at 12 months. CONCLUSION A randomized controlled trial comparing mBCG and RC will be challenging to recruit into. Around 10% of patients with high-risk HRNMIBC have a lethal disease and may be better treated by primary radical treatment. Conversely, many are suitable for bladder preservation and may maintain their prediagnosis QOL.

Delaying Radical Cystectomy for Muscle Invasive Bladder Cancer Results in Worse Pathological Stage

2003 ◽  
Vol 170 (4 Part 1) ◽  
pp. 1085-1087 ◽  
Author(s):  
SAM S. CHANG ◽  
J. MATTHEW HASSAN ◽  
MICHAEL S. COOKSON ◽  
NANCY WELLS ◽  
JOSEPH A. SMITH
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Invasive Bladder Cancer ◽  
Pathological Stage ◽  
Muscle Invasive Bladder Cancer ◽  
Muscle Invasive

POD-09.06: Radical cystectomy in nonmuscle invasive bladder cancer

Urology ◽  
2007 ◽  
Vol 70 (3) ◽  
pp. 29-30
Author(s):  
S.A. El Abd ◽  
A.R. Ramadan ◽  
M.D. El-Sharaby ◽  
M.A. El-Gharbawy
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Invasive Bladder Cancer ◽  
Nonmuscle Invasive Bladder Cancer

Patient Compliance With Maintenance Intravesical Therapy for Nonmuscle Invasive Bladder Cancer

Urology ◽  
2018 ◽  
Vol 118 ◽  
pp. 107-113 ◽  
Author(s):  
Shlomi Tapiero ◽  
Alexander Helfand ◽  
Daniel Kedar ◽  
Ofer Yossepowitch ◽  
Andrei Nadu ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Patient Compliance ◽  
Invasive Bladder Cancer ◽  
Intravesical Therapy ◽  
Nonmuscle Invasive Bladder Cancer
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