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.
best
Gemcitabin + Decetaxel sequential protocol
www.bccancer.bc.ca/chemotherapy-protocols-site/Documents/Genitourinary/GUBGEMDOC_Protocol.pdf
The result of clinical trial of Adstiladrin
www.urotoday.com/conference-highlights/asco-gu-2020/asco-gu-2020-bladder-cancer/119181-asco-gu-2020-safety-and-efficacy-of-intravesical-nadofaragene-firadenovec-for-patients-with-high-grade-bcg-unresponsive-non-muscle-invasive-bladder-cancer-nmibc-results-from-a-phase-iii-trial.html#:~:text=For%20patients%20with%20high%2Dgrade,%2C%20and%20hematuria%20(17%25).
