Intermediate-Risk Non-Muscle-Invasive Bladder Cancer: Treatment When BCG Immunotherapy Has Failed
Clinical scenario
This protocol addresses patients with non-muscle-invasive bladder cancer (NMIBC) classified in the intermediate-risk group — those without concurrent carcinoma in situ, and not meeting the criteria for low-risk, high-risk, or very high-risk groups — who have not achieved the required response to an initial course of BCG-based intravesical immunotherapy.
Previous treatment & reason for escalation
The prior treatment line consisted of intravesical BCG immunotherapy, delivered as an induction course of six weekly instillations followed by a maintenance phase with three-weekly instillations at 3, 6, and 12 months.
Goals not achieved — triggering escalation
Absence of high-grade bladder tumour recurrence on cystoscopy at 3 months, and negative urine cytology for high-grade urothelial carcinoma, were not reached. This failure to respond defines the BCG-unresponsive state that warrants the next step.
Next-line approach (partial overview)
For patients with BCG-unresponsive tumours in this setting, a surgical intervention directed at the bladder is a central consideration — full eligibility criteria, sequencing, and alternative considerations are detailed in the complete protocol.
References
- Patients without CIS who are not included in either the low-, high-, or very high-risk groups.
- Offer an RC to patients with BCG-unresponsive tumours.
- Treatments other than RC must be considered oncologically inferior in patients with BCG-unresponsive tumours.
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