Adapting Urology Practices in the Face of BCG Shortages


The impact of the BCG shortage on the treatment of bladder cancer, exploring various strategies adopted by urologists to optimize patient care. The conversation highlights the importance of risk stratification in deciding treatment protocols, considering factors like tumor size, location, multifocality, and histology, as well as patient age and overall health.

This is a synopsis of the Viewpoints video series featuring moderator, Sam S. Chang, MD, MBA, from Vanderbilt University School of Medicine, and panelists Gary Steinberg, MD, FACS, from Rush University Medical Center, Mark Tyson, MD, of Mayo Clinic Phoenix, Roger Li, MD, from Moffitt Cancer Center, and Sandip M. Prasad, MD, MPhil, of Morristown Medical Center.

In Episode 3 delves into the challenges and adaptations in the treatment of bladder cancer due to Bacillus Calmette-Guérin (BCG) shortages. Dr. Mark Tyson discusses the impact of the BCG shortage on their practice, including adopting strategies like dose splitting and a 'five plus two' strategy for BCG induction and maintenance. The importance of risk stratification is emphasized to ensure that high-risk patients receive priority for BCG treatment. Dr. Tyson also cautions against altering the BCG regimen too much, referencing the phase 3 NIMBUS trial which indicated reduced efficacy with modified dosing schedules.

The discussion then moves to programmatic changes in response to the BCG shortage. Dr. Tyson explains how their practice transitioned to a comprehensive bladder cancer program with centralized BCG approval, ensuring that high-grade patients receive full-dose BCG. This shift has successfully managed BCG allocation even during shortages. Gary Steinberg, MD, FACS, highlights the importance of considering multiple factors in risk assessment and treatment planning, such as tumor size, location, multifocality, and histology, along with patient age and overall health. He expresses concern about treating non-muscle invasive tumors with aberrant histology, such as micropapillary or squamous differentiation, due to the lack of sufficient data on their treatment. Dr. Steinberg's approach emphasizes the necessity of not exacerbating the patient's condition with overly aggressive treatment.

This episode underscores the ongoing challenges in bladder cancer treatment due to BCG shortages and the necessity of adapting clinical practices. It highlights the importance of risk stratification, programmatic changes, and individualized patient care in optimizing treatment outcomes.

*Video synopsis is AI-generated and reviewed by Urology Times® editorial staff.

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