What's interesting to me about this report is the omission of the treatment combination of BCG (reduced dosage) + Interferon. From everything I've read and heard this combo has greater efficacy and lower toxicity than BCG alone. Why would it not get mentioned in a report like this? curious, brewster
The Guideline comes to the following conclusions based on current literature:
* Accurate clinical staging upon which to base treatment decisions is critically important. The panel recommends performing a repeat TURBT prior to intravesical therapy in situations where there is high grade T1 disease without muscularis propria in the specimen and in select cases even when there is muscle present.
* A single, post-operative instillation of a chemotherapeutic agent may decrease recurrence risk in patients with superficial disease who have undergone uncomplicated resection of the tumor(s).
* There is no clear superiority of immunotherapy over chemotherapy for low risk disease. Induction courses of either intravesical chemotherapy or immunotherapy (BCG) should be administered in patients with an increased risk of tumor recurrence but low risk of progression.
* An induction course of mitomycin C in conjunction with maintenance therapy enhances the effectiveness of the drug in preventing recurrence, however, no determinations have been made in regard to optimal maintenance dose, schedule or duration.
* An induction course of BCG in conjunction with maintenance BCG therapy decreases recurrence and possibly progression in patients with higher risk tumors. Though no determinations on optimal schedule and duration have been made, data is available that supports the SWOG regimen.