What are the NCCN guidelines for the use of Bacillus Calmette-Guérin (BCG) immunotherapy as maintenance therapy for non-muscle invasive bladder cancer?

Updated: Nov 12, 2019
  • Author: Gary David Steinberg, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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The NCCN notes that data suggest maintenance BCG therapy reduces the recurrence rate of non–muscle invasive bladder cancer. For maintenance intravesical BCG, recommendations are as follows [3] :

  • Although there is no standard regimen for maintenance BCG, many NCCN Member Institutions follow the SWOG regimen consisting of a 6-week induction course of BCG followed by maintenance with 3 weekly instillations at months 3, 6, 12, 18, 24, 30, and 36
  • In the event of a BCG shortage, BCG should be prioritized for high-risk patients (eg, high-grade T1 and CIS), especially in the early maintenance period (ie, 3 and 6 months post-induction).
  • If feasible, the dose of BCG may be split (1/3 or 1/2 dose) so that multiple patients may be treated with a single vial in the event of a shortage.
  • • Ideally, maintenance should be given for 1 year for intermediate-risk and 3 years for high-risk NMIBC.
  • BCG would be withheld if traumatic catheterization, bacteriuria, persistent gross hematuria, persistent severe local symptoms, or systemic symptoms occur.
  • Dose reduction is encouraged if the patient has substantial local symptoms during maintenance therapy.

For more information, see Bladder Cancer.

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