Treatment Options Available for Bacillus Calmette-Guerin Failure in Non-muscle-invasive Bladder Cancer
Por:
Yates, DR, Brausi, MA, Catto, JWF, Dalbagni, G, Roupret, M, Shariat, SF, Sylvester, RJ, Witjes, JA, Zlotta, AR, Palou-Redorta, J
Publicada:
1 dic 2012
Resumen:
Context: Intravesical bacillus Calmette-Guerin (BCG) is a standard conservative treatment for patients with high-risk non-muscle-invasive bladder cancer (NMIBC). Many patients will experience recurrence or progression following BCG and are termed BCG failures.
Objective: To summarise the current treatment options available for patients with high-risk NMIBC who experience BCG failure.
Evidence acquisition: We searched the Medline, Embase, and Cochrane Trials databases for studies of BCG failure using predetermined relevant Medical Subject Heading terms and free text terms.
Evidence synthesis: Radical cystectomy (RC) should be strongly recommended when a patient has been deemed to fail BCG, if the patient is fit and fully informed of the risks, benefits, and quality-of-life issues. RC achieves long-term survival in excess of 90% with ongoing improvements in morbidity. While other salvage intravesical therapies have to be considered oncologically inferior to RC, several options are now available if bladder preservation is the objective. The options can be categorised as immunotherapy, chemotherapy, device-assisted therapy, and sequential combinations of these newer modalities with conventional therapy. Some agents have shown specific promise in BCG-failure patients (eg, gemcitabine, thermochemotherapy, taxane chemotherapy), and some modalities have been shown to be effective only in non-BCG-failure cohorts (eg, electromotive mitomycin).
Conclusions: The definition, prediction, and treatment of BCG failure remain unclear secondary to inconsistent studies and the heterogeneous entity of patients with NMIBC. RC should be the default position upon failing BCG, but if bladder preservation is sought, then several promising intravesical salvage options are available. It will be necessary to individually tailor the management of such patients based on tumour risk and medical profiles. Currently data are still inadequate to formulate definitive recommendations, and larger studies of salvage intravesical agents are urgently required. (C) 2012 European Association of Urology. Published by Elsevier B. V. All rights reserved.
Filiaciones:
Yates, DR:
Royal Hallamshire Hosp, Acad Dept Urol, Sheffield S10 2JF, S Yorkshire, England
Brausi, MA:
Dept Urol, Ausl Modena, Italy
Osped St Agostino Estense, Modena, Italy
Catto, JWF:
Royal Hallamshire Hosp, Acad Dept Urol, Sheffield S10 2JF, S Yorkshire, England
Dalbagni, G:
Mem Sloan Kettering Canc Ctr, Dept Urol, New York, NY 10021 USA
Roupret, M:
Univ Paris 06, AP HP, Fac Med, Acad Dept Urol La Pitie Salpetriere, Paris, France
Shariat, SF:
New York Presbyterian Hosp, Dept Urol, New York, NY USA
New York Presbyterian Hosp, Div Med Oncol, Weill Cornell Med Coll, New York, NY USA
Sylvester, RJ:
EORTC Headquarters, Brussels, Belgium
Witjes, JA:
Radboud Univ Nijmegen, Med Ctr, Dept Urol, NL-6525 ED Nijmegen, Netherlands
Zlotta, AR:
Univ Toronto, Princess Margaret Hosp, Dept Surg Oncol, Div Urol, Toronto, ON M5S 1A1, Canada
Univ Toronto, Mt Sinai Hosp, Univ Hlth Network, Toronto, ON M5S 1A1, Canada
Palou-Redorta, J:
Univ Autonoma Barcelona, Dept Urol, Fundacio Puigvert, E-08193 Barcelona, Spain
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