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High-Risk Non-Muscle-Invasive Bladder Cancer—Therapy Options During Intravesical BCG Shortage

Lookup NU author(s): Professor Rakesh Heer, Dr Mark Johnson



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Bladder cancer is the second commonest urinary tract malignancy with 70–80 % being non-muscle invasive (NMIBC) at diagnosis. Patients with high-risk NMIBC (T1/Tis, with high grade/G3, or CIS) represent a challenging group as they are at greater risk of recurrence and progression. Intravesical Bacilli Calmette-Guerin (BCG) is commonly used as first line therapy in this patient group but there is a current worldwide shortage. BCG has been shown to reduce recurrence in high-risk NMIBC and is more effective that other intravesical agents including mitomycin C, epirubicin, interferon-alpha and gemcitabine. Primary cystectomy offers a high change of cure in this cohort (80–90 %) and is a more radical treatment option which patients need to be counselled carefully about. Bladder thermotherapy and electromotive drug administration with mitomycin C are alternative therapies with promising short-term results although long-term follow-up data are lacking.

Publication metadata

Author(s): Veeratterapillay R, Heer R, Johnson MI, Persad R, Bach C

Publication type: Article

Publication status: Published

Journal: Current Urology Reports

Year: 2016

Volume: 17

Print publication date: 01/09/2016

Online publication date: 04/08/2016

Acceptance date: 02/04/2016

Date deposited: 19/01/2017

ISSN (print): 1527-2737

ISSN (electronic): 1534-6285

Publisher: Springer US


DOI: 10.1007/s11934-016-0625-z


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