Dr. Meeks on treatment options during the BCG shortage in bladder cancer


“The gemcitabine/docetaxel [combination] has been the answer that many people have needed,” says Joshua J. Meeks, MD, PhD.

In this video, Joshua J. Meeks, MD, PhD, recaps a session presented at the 2024 ASCO Genitourinary Cancers Symposium titled, “Bacillus Calmette-Guerin Shortage: What’s on the Horizon to Replace?” Meeks is an associate professor of urology, biochemistry, and molecular genetics at Northwestern University Feinberg School of Medicine in Chicago, Illinois.

Video Transcript:

It was a great session. It was built overall on drug shortages in oncology. It was interesting to see the comparison of the platinum shortage vs the BCG shortage. We've been dealing with this in non-muscle-invasive disease for the better part of last 7-8 years, trying to figure out how to treat patients. I think that some of this is really developed by us, as urologists. We said that patients need a lot of BCG, and they got that message, which is important. But I think the hard part of it is that most people don't have it. So, what are we doing in this setting? For example, we had probably about 6 weeks where we had no BCG. We had patients on therapy, so I had to reach out to them and say, "Listen, we can try and delay it, we can switch, but I have no therapy for you." The hardest is people who are just diagnosed. For them, it's super hard, because that was the one thing they knew was coming, and we just didn't have it. I think a lot of people have been inventive during this time; they've developed therapies.

The gemcitabine/docetaxel [combination] has been the answer that many people have needed. The question that people ask is, is it effective? The retrospective data looks really good. I'll tell you anecdotally, I don't see people showing up that got gem/doce who didn't have a response. It seems to be just as good, if not better in some cases. But that's being tested. So, a randomized trial, the EA8212, the BRIDGE trial, we'll see. It's a non-inferiority trial being asked directly, so [we’re] excited to see if it is noninferior. My gut sense is it will. The good news is that'll give us the data to say it is effective, but to a certain degree, based on what patients need and what providers have, it's taken over already for those who don't have BCG. We're also hoping that Merck will make more BCG; that's a big deal. Then, S1602 is the big clinical trial comparing Tokyo-172 to TICE. That's a randomized trial, noninferiority trial. Again, that trial was done in 2020, the data is coming due in 2023. We're also hoping that in the next year or so we'll have a sense about if it really was noninferior. That's certainly another strain that could be an opportunity to treat patients in the US.

This transcription has been edited for clarity.

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