10 months 3 weeks ago #60960 by joea73
Replied by joea73 on topic BCG
HI Sonny boy,

I think you are considered as BCG unresponsive and BCG intolerable.  
BCG unresponsive means that cancer came back (high grade / CIS) came back after an adequate BCG treatment.
By definition, adequate BCG treatment is the 5-6 weeks induction + 2-3 maintenance.

If CIS only, CIS's complete response increases from 55% after the induction course to over 80% after the initial maintenance treatment, so some urologist does cystoscopy  only after the completion of the maintenance.  For T1HG,  cystoscopy is done after the induction course, and if recurrence is found it is considered as BCG unresponsive.

I do not know what the initial pathology report said, so I assume it was T1HG or T1HG + CIS.

 For BCG unresponsive. in general urologist give one more chance before they recommend cystectomy.   Your urologist recommended BCG ( usually reduced to 1/3 dose) + Interferon Alpha but the  recurrence, which I presume HG or CIS, has happened.   At this point, cystectomy is the next step usually.  The rationale is that there are  data to show the longer cystectomy is delayed, the worse the prognosis is.  But there are patients who still want to try bladder preservation treatment.   Recently there are multiple bladder preservation treatment which  have been approved  and demonstrated its effectiveness for BCG unresponsive, i.e.  Immunotherapy (Keytruda) - systemic, Adstiladrin - intravesical, which uses adenovirus to deliver interferon alpha2b gene to cells to produce large amount of Interferon alpha2b proteins.  Adstiladrin was shown to inhibit Interferon alpha-resistant bladder cancer cells in the lab, then Gemcitabine and Docetaxel sequential treatment - intravesical.   It is  challenging to decide which treatment to receive including cystectomy,

Incidentally, because you cannot tolerate the side effects  you may be considered as BCG intolerable.  I do not know what side effect those new treatments will cause, but  below the side effects information on internet.   

Adstiladrin  -   discharge (33%), fatigue (23%), bladder spasm (19.7%), urgency (18%), and hematuria (17%).
Keytruda - fatigue, diarrhea, rash, pruritis, musculoskeletal pain, hematura, cough, nausea, constipation, uti, edema, hypothyroidism, nasopharyngtis.  
Gemcitabine -  are usually minor and may include an increase in the need to urinate, and the urge to urinate more often. These side effects usually stop several days after treatment.
Docetaxel - irritative urinary symptoms (22%), dysuria (16%) and hematuria (11%).

It is noted that Vancouver General Hospital in British Columbia, Canada is now recommending Gemcitabine/Docetaxel Sequential treatment for BCG unresponsive and BCG intolerable.  BCG invokes our immune system to help kill bladder cancer and Chemotherapy go into cancer cells and prevent the cancer cells to divide and lead it to death.  So, it may be possible that you may get side effects but not as severe as BCG treatment.     I have also listed the link to Gemcitabine and Docetaxel treatment monograph which is intended for.


Gemcitabin + Decetaxel sequential protocol

The result of clinical trial of Adstiladrin,%2C%20and%20hematuria%20(17%25).

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10 months 3 weeks ago #60951 by Sonnyboy
BCG was created by Sonnyboy
I'm not really replying to this post but unable to create a post of my own. I am unable to contact anyone as I don't know how to enable cookies on this site. So please bear with me. I was diagnosed with high grade non invasive bladder cancer Jan 2020. The tumor was removed then a mitomycin bladder wash, then subsequent BCG treatment which was somewhat effective but not totaly. then interferon was added to the BCG treatments with neg biopsies. Then the cancer was found in  urethra/prostate area (in situ). Had a TURP which removed the cancer and biopsies and cytology studies no further cancer. My problem is frequency. I can no longer tolerate the BCG/interferon treatments. The last treatment I was only able to hold the medication in about 15 minutes.  For the next few days I needed to urinate every 20 -30 minutes. I was getting up 20 times per night. Not just frequency but urgency issues as well. It gradually got better but it took about 6 weeks to get to the point I only have to go every hour. It has been 2 months and I get up 6 times per night. I am wondering what treatments may prevent recurrence other than BCG. My urologist was at first considering mitomycin but is now saying it is not the protocol. (I think that means the insurance won't pay for it as a phropylactic treatment only for existing cancer.) I am consulting another urologist by phone(my 2nd opinion guy) I just can't tolerate the BCG/interferon treatments. Help! Sorry for using this as a posting site.

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