Kamat - Figure 22
Journal of Clinical Oncology
FIG. 22: The International Bladder Cancer Group (IBCG) produced a white paper in 2016 that defined BCG refractory as “persistent high-grade disease at 6 months despite adequate BCG treatment.”[21] It also includes any stage or grade progression at 3 months after induction BCG. So if a patient progresses from Ta to T1 tumor, even at 3 months, this patient would be considered to be BCG refractory.
BCG relapsing is defined as “a patient who has a recurrence of high-grade disease after achieving a disease-free state at 6 months after adequate BCG.” The highest risk relapsing patients are those who recur within 6 months of last exposure to BCG.[22] This is especially important in patients undergoing maintenance therapy.
References
Kamat AM, Sylvester RJ, Böhle A, et al. Definitions, end points, and clinical trial designs for non-muscle-invasive bladder cancer: recommendations from the International Bladder Cancer Group. J Clin Oncol. 2016;34:1935−44 https://doi.org/10.1200/JCO.2015.64.4070
Lerner SP, Dinney C, Kamat AM, et al. Clarification of bladder cancer disease states following treatment of patients with intravesical BCG. Bladder Cancer. 2015;1:29−30 https://dx.doi.org/10.3233%2FBLC-159002
