Addressing Unmet Needs and Navigating BCG Shortages in High-Risk NMIBC

The expert faculty discuss persistent challenges and unmet needs in managing high-risk non–muscle invasive bladder cancer (NMIBC), emphasizing the impact of Bacillus Calmette–Guérin (BCG) shortages on patient care. They note that many cases of BCG-unresponsive disease stem from inadequate transurethral resection or incomplete adherence to BCG induction and maintenance protocols. The conversation highlights that, despite BCG’s proven efficacy, inconsistent delivery and supply constraints limit real-world outcomes. Faculty members describe how institutions are adapting to intermittent shortages by adjusting maintenance schedules, reducing doses, or sharing limited supplies among patients. They also explore the broader implications of supply issues, including barriers to clinical trial enrollment and variability in treatment access across regions. The panel underscores the urgent need to expand BCG production capacity, develop standardized rationing strategies, and investigate alternative or replacement therapies to ensure consistent and effective treatment for patients with high-risk NMIBC.