Table 1.

Reccomendations for intravesical BCG

RCTs and practice pattern research demonstrate that BCG immunotherapy in NMIBC reduces recurrences and progression, and affects mortality

3-week BCG maintenance is confirmed to reduce recurrence rates compared with induction alone, as well as metastasis and mortality compared with

BCG maintenance schedules other than the 3 week schedule show no significant benefit in RCTs

After the second BCG failure, or if the disease is BCG-refractory, radical cystectomy should be considered with alternatives considered a matter of investigation by clinical trials

In the period of around 1.5–2 years after the identification of high-grade NMIBC, nonradical alternative treatments for patients experiencing BCG-failure can be explored

Patients with BCG-refractory disease who are not candidates for cystectomy can be considered for chemoradiation

After the first BCG failure, patients (who have not progressed) have several treatment options, including repeated BCG (or continued maintenance), BCG plus interferon, single-agent intravesical chemotherapy (for example, mitomycin, gemcitabine, or valrubicin), sequential chemotherapy (for example, gemcitabine–docetaxel) or device-assisted chemotherapy

NMIBC: non-muscle-invasive bladder cancer; RCTs: randomized controlled trials; BCG: Bacillus Calmette Guerin