Carcinoma In Situ diagnosis

HI Duhhawaiian,

Before you decide,  you may want to discuss with urology  a few scenarios what if your disease does not responds to the next treatment, 

"If we do Gemcitabine, what will be treatment schedule like?"
"If we do Gemcitabine, how will we know that Gemcitabine is not working?"
"If we do Gemcitabine and it is determined that it is not working, what will be the next treatment options, RC or another bladder preservation treatment?"

If we do BCG, what will be the regimen like,  another try for 6 weeks induction + maintenance courses"?
If we do BCG. when we determine that another BCG is not working?
If we do BCG, what will be the next treatment, Gemcitabine?

I know someone who did not respond to T1HG+CIS after the first 6 weeks induction course, the urologist recommended BCG +i interferon with the standard regiment - 6 weeks + 3 years of maintenance.   I mentioned this because even 3 weeks maintenance could have improved the response, the fact, your disease did not respond after the 6 weeks induction course  may mean the chance of your disease responding to BCG alone may be so high. Accordingly, you may want to discuss if BCG+Interferon would give better chance for the disease to respond. BCG + interferon has been offered  to those initial BCG did not work.
 
In this case, you may want to ask If we do BCG, what will be the next treatment, Gemcitabine.

best

Hi Sara Anne,    Thank you very much.  I totally agree with you.  After my first round of 6 weeks BCG and the few weeks later with the scope my bladder looked good.  I wanted to go ahead with the maintenance regimen but my urologist said he doesn't do it that way and cut me off.  Not a good situation.  Now 9 months later he wants to do the Gemcitabine for urotileal carcinoma in situ.  I think I'm going to ask for the BCG again.   Which was my thinking.      Thanks lots Sara Anne.   Les

No I have not... yet. 
I have listed what I have found on internet about Joe Tippens Protocol is.  It sounds a bit complicated regimen.  

Dr Mukhopadhyay from MD Anderson first discovered mebendazole has potent anti-cancer activity in lab experiments in 2002. 


Joe Tippens Protocol 


Joe Tippens pioneered the human use of FenBen. Tippens uses Panacur C from  Merck Animal Health. Each gram of Panacur C contains 222 mg of fenbendazole.


Panacur C  one packet of powder (contains 222 mg of fenbendazole) each day for three days, and then  four days off.  You take the fenbendazole with or  without meals.


Comment: Although we don’t have human data, it seems to be safe at this dose, but again, consult your doctors. 


Vitamin E: 400-800 mg daily. Tippens uses Gamma E by Life Extension or Perfect E by Vitamin Discount Center.


Comment: I will reduce the dose Vit E to 200 mg or IU if you have heart disease. 


Curcumin: 600 mg daily.  Tippens uses the product Theracurmin HP by Integrative Therapeutics.


Comment: Generally safe. I use BCM-95®CG (Biocurcumax™) in my clinic simply because it was studied in clinical trials. 


CBD oil 25 mg daily. 


Comment: I use Green Road CBD oil capsules in my clinic. These capsules contain 25mg of  broad-spectrum CBD oil. You can take one capsule per day. 


No need for THC as a part of cancer treatment plan. But this may change as new data emerges. 

Link to Joe
i2b.us/fenbendazole-from-md-anderson-to-joe-tippens/#:~:text=Joe%20Tippens%20Protocol,and%20then%20four%20days%20off.

Has anybody tried Joe Tippens protocol or Care Oncology for bladder cancer?   Thank you

I saw a webinar by Dr. Ashish Kamat of MD Andersons, who is one of expertise for bladder cancer.   He showed a study which showed that for CIS,  6 weeks induction BCG treatment alone had 55% complete response (no recurrence, no progression).  The group who did not have 3 week maintenance course 3 months later,  the complete response rate went up  69%.  The group who had the 3 weeks maintenance course had the complete response rate went up to 85%.   It showed the durability of BCG treatment such that our immune system keep responding to BCG even after BCG treatment.

2.  AUA had come up with the definition of BCG unresponsive, which is defined as those who had an adequate BCG treatment but there was recurrence with high risk (HG and CIS).   Those with BCG unresponsive  will not benefit with further BCG treatment and should be offered alternative treatments including removal of bladder  and other bladder preservation treatment such as BCG +Interferon, Gemcitabine + Docetaxel sequential treatment, other intravesical chemotherapy like Gemcitabine, immunotherapy, etc.  The adequate BCG treatment is defined as 5-6 weeks induction course + 2-3 weeks maintenance course.  So, in your case, you have not been treated with adequate BCG treatment.    I would not know what the pathology report said from the initial TURBT.  But if I recall correctly, if the recurrence after 6 weeks induction course is T1HG, it is considered as BCG unresponsive.

I would seek for a 2nd opinion from a reputable cancer center if possible.

best