The current (January 2019) BCG shortage leaves two choices for those of us who would be using BCG right now, including me. We can wait for BCG or accept another treatment.
I will be trying (yet another) another option during this shortage. While I agree with Sara Anne's statement, "Mitomycin is not as effective as BCG", Mitomycin (MMC) is an effective treatment, and is one of the treatments of choice for those who fail to benefit from BCG. Some people respond to MMC who did not respond to BCG.
From the long article linked below, "Consensus Document", the following quote regards treatment for those who experience a "BCG failure".
"• 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. "[end quote]
BCG, if available, it the first choice because it has been shown to produce the "best" results for the" largest number" of patients, on a statistical basis. UNFORTUNATELY, What will work best for any particular individual is an unknown, and must be found through trial and error.
The choice to wait or use an alternate to BCG is up to each of us with consultation from care team; it is an individual decision, based on the status of our individual situations.
My bottom line is, "Don't automatically reject good options when the (statistically) best option is unavailable". Choosing to use an alternative now does not exclude the possibility of treating with BCG later. Talk to your care teamabout options open to you, in your situation.
See the BCG use and alternatives discussion in:
www.nature.com/nrurol/journal/v12/n4/full/nrurol.2015.58.html
Title: "Consensus statement on best practice management regarding the use of intravesical immunotherapy with BCG for bladder cancer"
Best to all
Jack