Management of non-muscle invasive bladder cancer

Management of non-muscle invasive bladder cancer

Tips and Tricks for BCG Administration

BCG, an attenuated mycobacterium developed as a vaccine for tuberculosis, has been shown to have significant anti-tumor activity in patients with non-muscle invasive bladder cancer, and is the most effective intravesical agent at reducing recurrence and disease progression for patients with non-muscle invasive bladder cancer with high risk features (high grade disease, lamina propria involvement, carcinoma in situ)1-5. BCG is stored in refrigeration and reconstituted from a lyophilized powder.

Emerging Intravesical Therapies for Non Muscle Invasive Urothelial Carcinoma

Although BCG is the reference standard for high risk non-muscle invasive bladder cancer (NMIBC), up to one third of patients recur, and a substantial number of patients progress to muscle invasive disease1. In addition, use of BCG is limited due to local or systemic toxicity in approximately 20% of patients. As a result, use of alternative intravesical agents has sparked significant interest in patients that are intolerant to BCG or not candidates for cystectomy due to competing risks.

Complications of Intravesical Therapy

More than 70% of urothelial carcinomas present as superficial, or non-muscle invasive bladder cancers (NMIBC). Recurrence and progression risk following transurethral resection (TUR) is multi-factorial, and is primarily associated with tumor size, stage, grade, and multifocality1. In 2007, the AUA guidelines committee released a consensus statement on the management of NMIBC (stages Ta, T1, & Tis), recommending a single dose of peri-operative intravesical therapy following TUR for papillary low volume non-histologically confirmed lesions as well as small volume, low grade Ta disease.

BCG and Mitomycin C Intravesical Chemotherapy for Non-Muscle Invasive Urothelial Carcinoma

Following prostate, lung, and colon cancer, bladder cancer is the fourth most common malignancy in men in the Western world1. Predominantly urothelial carcinomas, more than 70% present as superficial, or non-muscle invasive bladder cancers (NMIBC)2. Bladder cancer is traditionally diagnosed and initially managed with transurethral resection (TUR), which facilitates accurate tumor staging and grading and can provide local disease control. However, NMIBC recurs at rate of 50-80% and has a 14% chance of disease progression following TUR alone.