Chapters Transcript Video Debate on Management of HG T1 Bladder Cancer in the Era of BCG-shortage: Alternative Intravesical Therapies Back to Symposium Dr. Armine Smith, Director of Urologic Oncology at the Johns Hopkins Sibley Memorial Hospital, details her presentation given at MA-AUA 2023. So I'm going to be presenting at mid Atlantic uh A U A meeting on alternative intravesical therapies for high grade PT one bladder cancer, which is considered high risk uh bladder cancer as far as the uh ability to progress and recur and cause significant morbidity and mortality in patients. Um And the gist of my talk is um that we are going to compare BC G which is in um shortage um on and off for the past few years across the world. Um And seeing if there are any alternative therapies that can take place of it with the uh equivalent efficacy. Looking at the BC G numbers uh from the data from a lot of the meta analysis, we know that uh the re recurrence, free survival, progression, free survival um is in the upwards of nineties when the BC G is given as an induction therapy and the recommended maintenance spread. And unfortunately, with the BC G shortage, a lot of the places are deprived of the BC G. And um the A, a recommendation has been to either give a induction course and skip the maintenance if there is no availability or come up with some alternative drugs to use. Uh When we look at the uh data comparing um the uh lower uh BC G um dosage versus uh kind of reduced frequency of BC G. We know that reduced the frequency of BC G is um uh gives substandard outcomes. It cuts about um in half both the recurrence free survival and the progression free survival in the patients. So what we do is um we look at the other alternatives such as um intravesical chemotherapy agents, the intravesical chemotherapy agents that have been used sometimes on label, sometimes off label are mitoMYcin, gemcitabine, epiRUBicin, Adriamycin, DOCEtaxel valin. When we look at the comparison of these single agents to BC G. Unfortunately, these numbers are a little bit lower than BC G. So we do need to come up with even better strategies. One combination that has come up um in the past few years is the combination of gamine and DOCEtaxel. We have uh some real world uh evidence. And uh unfortunately, from retrospective trials, mostly uh that shows a fairly good performance of this drug regimen. Uh These numbers are in upwards of eighties and uh uh BC G naive patients and about 50% in patients who have failed BC G in the past. Um There was a single arm um trial that has concluded or that has run up the Hopkins uh looking at the BC G naive patients who received um genocide doy Taxol combination and that showed about a 12 month um complete response of upward of 80. So this is a fairly, fairly promising um regimen for us. We do have a randomized trial open and running for BC G uh versus uh gem Camin Doy Taxol that will give us even more robust data. And this trial is open in multiple institutions. One good thing to uh look forward to. There are a myriad of trials that are open and running in the non muscle invasive bladder cancer space um both in the intermediate risk, um high risk BC G naive and BC G unresponsive with very um creative uh kind of solutions and some immunotherapy agents and some other um agents that kind of enhance the response of the uh the bladder lining to um the therapy to eliminate the cancer. And we know this will generate some very interesting data. So hopefully in the next few years, we'll have even more alternatives uh to the BC G. Created by
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