Second-line intravesical therapy versus cystectomy for bacille Calmette-Guerin (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-Guerin. Recent findings The addition of interferon to bacille Calmette-Guerin has proven to be an effective combination therapy for bacille Calmette-Guerin 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-Guerin failures. Summary New treatment modalities are being introduced and existing ones improved to treat bacille Calmette-Guerin-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.