ORLANDO, FL (UroToday.com) - Professor Witjes pointed out that bladder cancer incidence is much higher in Europe than in the US. He reviewed the AUA guidelines for T1G3 TCC. BCG with maintenance should be given and cystectomy should be considered an option. This is similar to the EAU guidelines. The rationale for BCG is the potential impact on disease progression is maintenance therapy is given.

Three-year cancer specific survival is high in low risk patients, but only 65% in high risk and <40% in invasive disease. Additional BCG should be given for persistent CIS. Often, recurrence in the first 6 months suggests that it was not delivered adequately. Yet there are alternatives, he said. Valrubicin had a 30% CR at one year but ongoing CR was disappointing. Eoquin is a new agent that ablates 68% of marker tumors, but no data is known in BCG failures. Gemcitabine is well tolerated and has an ablative effect up to 56%. It has potential in BCG failures and is under investigation.

Electromotive Delivery of Drug Administration may enhance outcomes and is presently experimental. Its use with BCG is unknown. Synergo is a hyperthermic/MMC combination that has a 94% CR rate for initial treatments. It has a good safety profile and is effective in ablation and prophylaxis.

He concluded that BCG can be given again in BCG failures in exceptional cases, but cystoprostatecomy remains his standard of care.

Presented by J. Alfred Witjes, MD, PhD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.