Challenges in the treatment of bladder cancer like BCG shortage, chemotherapy and alternative therapies were examined in the plenary session of the 15th Central European Meeting (CEM15) with experts looking into issues like adverse effects and efficacy of standard medical procedures.
Prof. Marko Babjuck (CZ), chairman of the EAU Guidelines panel on bladder cancer, lectured on how and when to treat with Bacillus Calmette-Guerin (BCG) and discussed, among others, the efficacy of BCG and the prognosis of patients with recurrent disease, post-BCG, or when it fails against aggressive cancer tumours.
He noted that surgery or radical cystectomy is standard option following BCG failure and looked into key issues like timing of surgery. Alternatives such as intravesical chemotherapy and device-assisted instillations of chemotherapy and further immunotherapy were also examined with Babjuk noting obstacles like the current BCG shortage and intolerance by some patients with the drug.
“What do we really need? We should have improved efficacy of local treatment and find better options than BCG,” said Babjuk whilst adding that better predictors for better selection of patients for cystectomy also play a crucial role.
Meanwhile, T. Smrkolj (SI) presented on the alternatives to cystectomy in the treatment of muscle-invasive bladder cancer (MIBC). He looked into options like TURBT (transurethral resection for bladder tumor) alone, multi-modality treatments, and radiotherapy such as external beam radiation therapy (EBRT).
“TURB alone should only be considered as a therapeutic option for muscle-invasive disease after radical TURB, when the patient is unfit for cystectomy or a multi-modality bladder-preserving approach or when the patient refuses surgery,” noted Smrkolj.