Overview of BCG-Unresponsive Non-Muscle-Invasive Bladder Cancer (NMIBC)


Neal Shore, MD, FACS, provides an overview of BCG-unresponsive non-muscle-invasive bladder cancer (NMIBC), with a focus on patient presentation and risk stratification.

This is a video synopsis/summary of an Investigator Perspectives featuring Neal Shore, MD, FACS.

Dr Neal Shore discusses the intravesical therapy bacillus Calmette-Guérin (BCG), an attenuated form of Mycobacterium bovis bacteria, which has been the standard of care for treating non–muscle-invasive bladder cancer (NMIBC) for multiple decades thanks to pioneering work by Dr Pablo Morales. BCG is typically administered weekly for 6 weeks as an induction course. For patients with high-risk NMIBC, including those with high-grade papillary disease, T1 invasion into the basement membrane (also known as the lamina propria), carcinoma in situ, or a combination, maintenance doses are given for up to 3 years based on the SWOG trial demonstrating reduced recurrence and progression rates.

Due to BCG shortages over recent years, Dr Shore generally reserves BCG for high-risk NMIBC patients. Classic BCG-unresponsive disease is defined as persistent disease after at least 2 consecutive induction courses with at least 5 of 6 doses (or persistent disease after induction) plus at least 2 of 3 maintenance doses at 3 and 6 months.

Patients with BCG-unresponsive high-risk NMIBC can present with gross hematuria, usually with initial or terminal blood, or microscopic hematuria, defined as more than 3 red blood cells per high-power field. Risk factors to identify patients warranting evaluation include smoking, alcohol use, exposures to industrial or environmental pollution, and possibly family history. Many patients with idiopathic microscopic hematuria will not develop bladder cancer.

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

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