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Current Clinical Problems in Bladder Cancer
Activity Four Title
How to Treat Bladder Cancer When BCG is Unavailable
- Prof. Fred Witjes
When dealing with patients with non muscle-invasive bladder cancer (NMIBC) know the different risk profiles and what that means for treatment choice (AUA and EAU guideline). This means that BCG shortage or unavailability is an issue in intermediate and high risk disease. In intermediate risk we can safely use one year of chemotherapy as alternative. This means a slightly increased recurrence rate, but not more progression.
In the higher end of the intermediate disease and high risk disease BCG is an issue. Beware that the alternatives for BCG unavailability will overlap with the alternatives for BCG non responsive disease, as discussed by Dr Kamat.
What are some conclusions in case of high risk disease and BCG shortage? Prediction of response is not ready yet for use in daily practice. A less intense BCG schedule can be used safely, so consider reduction of the number of instillations per course (omit the last one), the treatment time (1 instead of 3 years) and the dose (1/3 dose). Finally, combination / sequential therapy does not seem the answer in high grade Ta disease.
What can we conclude in case of BCG unavailability? In high risk patients intravesical chemo or combination therapy does not seem to be a solid answer. Other immunotherapies were/are interesting, but need revitalization or further studies. Device assisted therapies (especially radiofrequency (RF) induced hyperthermia) certainly is an option. The future, however, looks bright since new strategies and drugs are being explored. Finally, a radical cystectomy does not seem to be the first choice for high grade Ta in case there is no BCG.
This activity is intended for medical professionals who have a clinical interest in the management of bladder cancer: urologists, medical oncologists and radiation oncologists as well as primary care physicians, advanced Practice Nurses, Nurse Practitioners, Physicians Assistants, Managed Care Medical Directors, and other Practitioners and Payers.
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Educational Activity Agenda
Understanding the spectrum of tumors after BCG failure
Release and Expiration Dates
Enduring Archive Release Date: December 6, 2017
Disclosure of Conflicts of Interests
Global Education Group requires instructors, planners, managers and other individuals and their spouse/life partner who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Global for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.
The faculty reported the following financial relationship or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:
H. Barton Grossman, MD
Ashish M. Kamat, MD
Maximilian Burger, MD
Yair Lotan, MD
Fred Witjes, MD
Arnulf Stenzl, MD
Sharokh Shariat, MD
James Catto, MD
Planners and Managers
The planners and managers reported the following financial relationship or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:
Ashley Marostica, RN, MSN
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