Initial Treatment Selection for NMIBC in the Era of BCG Shortage


The various treatment approaches for NMIBC in the context of a BCG shortage, with a focus on initial cases, are shared. Urologists discuss their strategies for treating a hypothetical patient with a 3 cm bladder tumor, weighing options like perioperative chemotherapy, the importance of thorough resection, and adapting treatment protocols based on tumor characteristics and the ongoing BCG shortage.

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.

Episode 4 features a detailed discussion on the impact of the Bacillus Calmette-Guérin (BCG) shortage on bladder cancer treatment strategies. The panelists share insights around a hypothetical case of a patient with a 3 cm bladder tumor. The panelists, led by Dr. Sam S. Chang, explore various treatment options such as perioperative chemotherapy, emphasizing the significance of a thorough tumor resection. Dr. Roger Li discusses the importance of Transurethral Resection of Bladder Tumor (TURBT) and ensuring comprehensive bladder coverage during the procedure. The panel also touches on the necessity of upper tract imaging in these cases. Dr. Mark Tyson shares his insights on adapting to the BCG shortage, mentioning strategies like dose splitting and the ‘five plus two’ regimen to conserve BCG. He also references the Phase 3 NIMBUS trial, underscoring the potential risks of altering BCG regimens. The panel then discusses the importance of risk stratification in treatment planning, especially in light of the BCG shortage.

Gary Steinberg, MD, FACS, brings up the consideration of tumor characteristics such as size, location, and histology, along with the patient's age and overall health, in individualizing treatment. He also discusses his approach to managing high-grade TA lesions, emphasizing the role of repeat resections and BCG induction in certain cases. Roger Li, MD, and Mark Tyson, MD, contribute their perspectives on treating high-grade TA lesions during the BCG shortage, including using combinations of gemcitabine and docetaxel as alternative therapies. They highlight the potential of these regimens in well-selected patients.

This episode emphasizes the importance of adapting bladder cancer treatment strategies in the face of BCG shortages, considering various factors such as tumor characteristics, patient health, and the need for personalized care in optimizing treatment outcomes.

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

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