Recurrent T1HG Bladder Cancer after BCG: More Intravesical Therapy or Radical Cystectomy?

Frances M. Alba, MD, discusses the management of T1 high-grade bladder cancer, focusing on cases that recur following BCG therapy.

In this 14-minute talk, Dr. Alba introduces the case of a 53-year-old male with T1 high-grade bladder cancer who underwent a complete six-week BCG course but experienced recurrence within ten weeks. Dr. Alba notes that BCG failure is not uncommon, with the term "BCG unresponsive" now used to describe persistent or recurrent disease within defined timeframes after adequate BCG treatment. In these patients, continued BCG is seldom effective.

Alba highlights the AUA guidelines for these patients, recommending cystectomy as the best chance to prevent disease progression. Despite its efficacy, only a quarter of urologists in the US recommend cystectomy for BCG-unresponsive cases, with many preferring intravesical chemotherapy. Gemcitabine-docetaxel combination therapy shows promise. Alba also shares additional options, such as nadofaragine, pembrolizumab, and novel therapies, including N-803.

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