The UroOnc Minute: Navigating BCG Maintenance Therapy in NMIBC, With Mark D. Tyson, II, MD, MPH

Welcome back to The UroOnc Minute!

In this episode of The UroOnc Minute, host Adam B. Weiner, MD, welcomes Mark D. Tyson, II, MD, MPH, a professor of urology at Mayo Clinic in Phoenix, Arizona, to discuss the role of maintenance therapy in non–muscle invasive bladder cancer (NMIBC). Tyson emphasizes that induction plus maintenance BCG remains a cornerstone of treatment for patients with intermediate- and high-risk NMIBC, noting that maintenance therapy is a key component of BCG’s efficacy and that evidence does not support substantially reducing the number or frequency of instillations.¹ Despite the strength of the data, however, real-world implementation remains challenging, with BCG shortages, treatment-related toxicity, and other barriers preventing many patients from completing recommended maintenance schedules.

Tyson discusses practical approaches to managing these challenges, including strategies for prioritizing BCG during periods of shortage, using reduced dosing or modified schedules when appropriate, and allowing additional time between treatments for patients experiencing significant bladder symptoms. He also shares his approach to managing BCG-related cystitis and other toxicities, including the potential role of medications and temporary treatment breaks.

Looking ahead, Tyson highlights several emerging strategies that could reshape the treatment landscape for NMIBC, including newer BCG formulations that may help to address the ongoing BCG shortage. He also discusses the potential role of combination immunotherapy and BCG in select patients with BCG-naïve NMIBC who are at particularly high risk of progression. In the BCG-unresponsive setting, Tyson highlights emerging agents that may further expand treatment options, such as cretostimogene grenadenorepvec, detalimogene voraplasmid, and TARA-002.

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