Managing High-Risk NMIBC
Transcript: Neal Shore on BCG maintenance for NMIBC
Dr. Neal Shore
Interview recorded February 2025. All transcripts are created from interview footage and directly reflect the content of the interview at the time. The content is that of the speaker and is not adjusted by Medthority.
It's always really interesting to look at trial literature and compare it to the real world evidence. There's always, sometimes, just fascinating discordances. I guess I'm not surprised to see that, you know, 50%, less than 50% of high-risk NMIBC patients didn't get maintenance therapy, BCG maintenance therapy based upon the really sort of pioneering work by Don Lamm in the SWOG trial. Actually, only about 17% of the patients in that trial got the full three years of maintenance.
You know, sometimes, well, could it be a shortage, could it be intolerability, could it be, you know, just other issues regarding throughput in clinics? You know, asking somebody to do more than a year of any kind of therapy that they have to come in and be instrumented, in this particular case, intraurethral, intravesical medication, has issues, but I think for somebody who is particularly high-risk NMIBC, you know, my recommendation typically has been, especially during, you know, the COVID pandemic, as well as when we had some concomitant BCG supply chain issues, to really push towards, you know, two years, but, you know, I think there is a spectrum of response, there is a spectrum of high-risk disease for NMIBC. You know, a Ta G3, a solitary lesion, versus multifocal CIS, versus T1, I think all of our colleagues recognise that there's, you know, a different gravitas we take to making the decision on maintenance and the duration of maintenance, especially in line with, you know, patient tolerability. Now, that's, I think maybe this real world data is sort of getting at this whole art of medicine. You know, we do trials to get level one evidence, the level one evidence for high-risk NMIBC and then the guidelines, outside of a shortage, suggests that we give more than one year of maintenance therapy, but nonetheless, I think it's important to see what these investigators demonstrated and, you know, take away from that that it's an opportunity for additional education and discussion.
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