What are the alternatives to BCG for non-muscle-invasive bladder cancer?

A high-interest topic at the AUA meeting. There is a worldwide shortage of BCG.

Happily, it appears that instillation of combination gemcitabine+docetaxel chemotherapy, which is not new, is better tolerated and nearly as effective as BCG. And gemcitabine+docetaxel may be used as maintenance therapy after induction with BCG in BCG responders.

Pembrolizumab is an intravenous treatment, which is also effective, but much much more expensive than the bladder instillation options.

There are a number of very new and very expensive agents being evaluated, many of which show promise.

The happy outcome is that we may be able to preserve patients' bladders by managing the cancer telescopically and with one or more of these adjunctive measures, before needing to progress to cystectomy surgery.