Defining BCG Response and Optimizing NMIBC Management

The expert faculty explore the definitions, management strategies, and evolving treatment approaches for patients with Bacillus Calmette–Guérin (BCG)-naïve and BCG-unresponsive non–muscle invasive bladder cancer (NMIBC). They clarify how the FDA now standardizes the definition of BCG-unresponsive disease, requiring adequate induction and maintenance before determining resistance. The discussion distinguishes truly BCG-naïve patients from those who have not received BCG for several years and examines how these categories inform clinical trial eligibility and therapeutic decision-making. Faculty members highlight that while radical cystectomy remains the gold standard for high-risk disease, many patients may benefit from bladder-sparing strategies using novel intravesical or systemic agents. The conversation also emphasizes the importance of BCG maintenance therapy, referencing data from pivotal trials such as CREST and POTOMAC that validate maintenance as essential for durable responses. The faculty agree that optimizing induction and maintenance remains critical to preventing recurrence and progression in NMIBC.