BCG Treatment for Bladder Cancer
High Risk Pa ents
➤ ➤ BCG therapy for high risk patients should be considered standard of care
(Figure 1). (A)
• Maintenance BCG is critical for successful management of high risk patients.
• The SWOG schedule offers the best efficacy.
➤ ➤ High risk (high grade) patients should receive maintenance BCG therapy
for 3 years, while intermediate risk patients should receive maintenance
therapy for ≥1 year. (A)
➤ ➤ Patients with residual or recurrent CIS at the 3 month cystoscopy may
benefit from 3 additional weekly BCG treatments, but those with disease at
6 months should be considered unresponsive to BCG. (B)
➤ ➤ Intravesical chemotherapy is a reasonable option for those patients who do
not tolerate intravesical BCG.
Intermediate Risk Pa ents
➤ ➤ BCG induction and at least 1 year of maintenance therapy should be used for
patients with intermediate risk tumors. (A)
• Risk stratification should be the basis for deciding therapy, with careful
assessment and definition of of the tumor risk category in transition from low
risk to intermediate risk.
Low Risk Pa ents
➤ ➤ Low risk patients should not receive BCG (Figure 1).
See Figure 1 note for definitions of Low, Intermediate and High Risk
stratification levels.
