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BCG shortage
My husband had a TURBT two weeks ago today. The doctor says BCG isn’t available. Does anyone know where it might be available? His is high grade non invasive. Had two lesions. The doctor didn’t do a chemo wash after the surgery which worries me. We’re due to start Gemcitibine within the week. Seems like too long to wait to start treating. We’re seeing Dr. Guruli at VCU in Richmond. Would love some support.
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9 Replies
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That is my understanding. Good explanation. Thank you.
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It’s hard to read medical journals and articles that seem to conflict with each other. Even Doctors give different names for some of the same terms.
BCG: My understanding of BCG, is that it is used for BC as an Immunotherapy, applied directly into the bladder, and it forces the bodies own immune system to attack the cancer cells.
Gemcitabine: Is a Chemo, that yes, can be used for BC as an Immunotherapy, applied directly into the bladder, however, Gemcitabine attacks the cancers cells themselves, and doesn’t rely on the bodies immune system to do the attacking.
Is this correct?
TURBT Jan 2019; Diag: CIS
Induction BCG (Mar 19) /Maint BCG (Aug 19)
TURBT Nov 2019; Diag: CIS
Repeat Induction BCG – Jan 2020 Complete
Cleveland Clinic is starting to show the shortage as well. Had 1 BCG treatment last week and #2 will be on June 14, 2019. After that, there may be no more in Cleveland Clinic. We are feeling desperate for the upcoming BCG treatments and do not know where to go to get it either.
There is a bit of confusion here between post operative treatment where something like mitomycin or gemcitabine is given as a wash immediately after the TURB and treatment done several weeks afterward when the drug is instilled into the bladder and left for several hours. There is also a difference in dose. This quote refers to the former.
Sara Anne
Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
Forum Moderator
The most common types of postoperative intravesical chemotherapy used to treat NMIBC are gemcitabine and mitomycin C, Dr. Ristau says. “These drugs have been shown to reduce recurrences of non-muscle invasive bladder cancer when given in the immediate postoperative setting,” he said. One study found a 12 percent reduction in the risk of recurrence in patients treated with gemcitabine. Other studies have found treatment with mitomycin C reduces the risk of recurrence by 10-15 percent.
://www.urologyhealth.org/
First, Gemcitibine is not being used as “chemo.” It is being used just like BCG to stimulate the immune system in the bladder itself. You would not want a chemical of any kind instilled into the bladder while there still is an open wound that hasn’t quite healed. That would be quite dangerous. This is why there is usually about a month’s wait between the TURB (biopsy) and intravesical treatment such as this.
Chemotherapy is when the drug(s) are given systemically, usually via an intravenous injection or infusion, and affect the entire body. This is done when the cancer has spread outside the initial organ. In your husband’s case the cancer is still confined to the bladder so that whatever drug is administered (BCG or Gemcitibine) can be used as a “wash” at a stronger concentration directly on the cancer.
Sara Anne
Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
Forum Moderator
I knew waiting to heal was true for BCG treatments, but I was under the impression that with chemo it needed to be started ASAP.
Thank you.
Merck, the company whose subsidiary produces BCG, has stated that they think the supplies will be back to normal by September. Unfortunately, BCG is a biological product and there is only one source in the US. This has been a recurring problem.
Gemcitibine is a recommended substitute. And one month is not too long to wait. Doctors want to give the bladder time to heal from the surgical wounds caused by the TURB procedure. Your husband is right on schedule.
Sara Anne
Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
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