Expert Discusses Strategies for Managing BCG Shortage in Bladder Cancer

Collaborating with other providers and limiting dosing for certain patients with bladder cancer are some strategies that may help with navigating the current shortage of Bacillus Calmette-Guerin (BCG), said Joshua J. Meeks, MD, PhD, BS.

In a conversation with CancerNetwork^® during the 2024 Genitourinary Cancers Symposium, Meeks, an associate professor of Urology, Biochemistry and Molecular Genetics at the Northwestern University Feinberg School of Medicine and a section chief of Robotic Surgery at the Jesse Brown VA Medical Center, spoke about his presentation on the current BCG shortage and discussed what oncologists y practices could do to treat patients during this scarcity. For example, if BCG supplies are limited, he suggested offering gemcitabine/docetaxel to patients or considering cystectomy as alternatives for managing disease.

Transcript:

There’s obviously reduction, so we and only giving give [BCG] to [patients with] high-risk [disease] patients. Second, we may only give a year of therapy and cut down the number of doses we’re giving people. Then, we sort of coordinate it where people are getting a third- or half-dosing and coordinating when patients come to the clinic when there’s 2 or 3 people at a time. That’s if you have some [BCG] but not enough. I think the next part of it is saying “Well, down the street they have it, so why don’t you get therapy there?” That’s just very reasonable. It happens a lot in Chicago; I think it’s very common for people to work as a team with other providers wherever they are to try to get patients to where they need to be. If that’s not feasible, I think the next best thing is gemcitabine/docetaxel while still coming up with a new solution. For clinical trials, there’s a lot of trials in this setting. [For example], if you open SunRISe-3 [NCT05714202], a third of patients could get BCG. Those are all options. And for looking at [whether] the patient will respond, talking about cystectomy is another possibility.

The shortages are here. They’re going to be [here] whether it’s supply and demand; they clearly keep coming. The biggest thing is trying to increase the number of options for people, but it’s going to be at a cost. Many of these new therapies are very expensive, but I tend to think that our precision approach is trying to figure out—maybe everybody doesn’t get the same thing—that there’s certain things that will work better in certain patients. We have kind of abandoned that in early-stage bladder cancer, but maybe it’s something we should be looking back on again.

Reference

Meeks JJ. Bacillus Calmette-guerin shortage: what’s on the horizon to replace? Presented at the 2024 ASCO Genitourinary Cancers Symposium; January 25-27, 2024; San Francisco, CA.