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BCG Refractory Disease

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Bladder Cancer

Part of the book series: Current Clinical Urology ((CCU))

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Abstract

For the last 30 years, we have depended upon Bacillus Calmette-Guerin (BCG) therapy to reduce the recurrence of non invasive urothelial carcinoma of the bladder and prevent the progression to muscle invasive disease. Since Morales first reported the efficacy of BCG in 1976, no other form of systemic or intravesical therapy has produced comparable response rates especially with carcinoma in-situ or high grade disease (1, 2). Our confidence in this proven treatment is humbled by the fact that we lack the ability to identify those tumors which will be unresponsive to BCG and express a malignant phenotype for invasion and metastasis. While most patients with noninvasive urothelial tumors can preserve their bladders, a delay in cystectomy for some may put them at risk of developing incurable metastatic disease. In this chapter we will attempt to define BCG refractory disease, identify the risks with salvage therapy, report on biological markers of progression, introduce new therapies and suggest a treatment algorithm for approaching urothelial carcinomas that fail BCG therapy.

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Authors and Affiliations

  1. Department of Urology, University of Arkansas, Little Rock, AK, USA

    Tara Allen

  2. Department of Urology, University of Arkansas for Medical Sciences, Little Rock, AK, USA

    Graham F. Greene

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  1. Tara Allen
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  2. Graham F. Greene
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Correspondence to Graham F. Greene .

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Editors and Affiliations

  1. Dept. Urology, University of Michigan Health System, E. Medical Center Dr. 1500 , Ann Arbor, 48109-0252, U.S.A.

    Cheryl T. Lee

  2. Dept. Urology, University of Michigan Health System, E. Medical Center Dr. 1500 , Ann Arbor, 48109-0252, U.S.A.

    David P. Wood

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Allen, T., Greene, G.F. (2009). BCG Refractory Disease. In: Lee, C., Wood, D. (eds) Bladder Cancer. Current Clinical Urology. Humana Press. https://doi.org/10.1007/978-1-59745-417-9_11

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  • DOI: https://doi.org/10.1007/978-1-59745-417-9_11

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