Witjes - Figure 21
Options to "save" BCG
FIG. 21: This Figure lists some options for conserving BCG.[10] One option will be to use 1 year of maintenance instead of 3; there will be some more recurrences, but not more progression. Another option is to use 2 instead of 3 maintenance treatments (1 is insufficient) or maintenance therapy with a lower dose, such a 1/3 dose. Again, there will be more recurrences, but not more progression.
Carcinoma in situ should be treated with 3 years of maintenance therapy, although the dose can be reduced to 1/3 in the 2nd and 3rd years. The practical problem with the 1/3 dose is that it cannot be used with a closed system; it must be prepared in the pharmacy, and patients must be clustered in groups of 3 per day to be able to use all the doses.
References
Mostafid AH, Palou Redorta J, Sylvester R, Witjes JA. Therapeutic options in high-risk non-muscle-invasive bladder cancer during the current worldwide shortage of bacille Calmette-Guérin. Eur Urol. 2015;67:359−60 http://dx.doi.org/10.1016/j.eururo.2014.11.031
