Second-line intravesical therapy versus cystectomy for bacille Calmette-Guérin (BCG) failures.

PURPOSE OF REVIEW: To give an update on the new modalities in treating patients with superficial bladder cancer who have failed bacille Calmette-Guérin.

RECENT FINDINGS: The addition of interferon to bacille Calmette-Guérin has proven to be an effective combination therapy for bacille Calmette-Guérin failures. Electromotive intravesical mitomycin C as well as local microwave hyperthermia have been shown to improve drug delivery and increase response rates. Intravesical gemcitabine has shown some promising results in phase I studies and is being investigated in phase II trials. Photodynamic therapy is proposed as a second-line therapy for bacille Calmette-Guérin failures.

SUMMARY: New treatment modalities are being introduced and existing ones improved to treat bacille Calmette-Guérin-refractory superficial bladder cancer. These agents need to be studied in large randomized trials. Until these agents prove to decrease recurrence rates and delay progression of high-risk superficial bladder cancer, cystectomy remains the standard of care for the patient who is a good surgical candidate and willing to undergo such major surgery.