BCG Treatment for Bladder Cancer
➤ ➤ Clinical parameters (grade, stage, presence of carcinoma in situ (CIS), age, and
pattern of prior BCG failure) are the strongest predictors of response to BCG.
➤ ➤ Wait at least 2 weeks after TUR to start induction BCG (6 weekly treatments).
➤ ➤ For maintenance, use the 6+3 schedule (also known as the 'Lamm' or 'SWOG'
schedule). (A)
➤ ➤ Use full doses of BCG for induction, and dose reduction during maintenance,
if necessary, based on side effects. (A)
➤ ➤ Patients with increasing disease (number, size, grade, or stage of disease) at
the 3 month cystoscopic examination should be considered unresponsive to
BCG, and alternate treatment should be instituted. (B)
➤ ➤ Patients who have recurrent disease after adequate BCG treatment should
undergo evaluation of upper tracts and prostatic urethra, followed by
intravesical immunotherapy with M. bovis or intravesical chemotherapy.
➤ ➤ Continued BCG is not useful in patients with BCG unresponsive disease
(see full Consensus Statement*). These patients should be offered radical
cystectomy.
➤ ➤ BCG should not be administered in the presence of active infection.
• Asymptomatic bacteriuria does not appear to increase toxicities or risk. (B)
• BCG appears to be safe and effective in select patients who are
immunosuppressed, based on small cohort studies. (C)
➤ ➤ Oral quinolones should not be administered prior to, or within 6 hours of,
BCG instillation but, when given appropriately, can reduce BCG toxicity. (A)
➤ ➤ There is no evidence that combination BCG plus interferon is more effective
than BCG alone. (B)
Consensus Recommenda ons
➤ ➤ The use of lidocaine or excessive lubricants is not recommended with the
administration of intravesical BCG.
➤ ➤ It is not necessary to rotate patients every 15 min post BCG instillation.
However, patients should hold the BCG in their bladder for 2 hrs.
➤ ➤ Patients should be provided with a template to record BCG treatment/
cystoscopy dates and bring it to subsequent appointments (see full Consensus
Statement for template*).
* h ps://jitc.biomedcentral.com/ar cles/10.1186/s40425-017-0271-0
