Editing Non-Muscle Invasive Bladder Cancer (section)

=== Categories of BCG failure (4) ===

* 2016 International Bladder Cancer Group Definitions[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5321095/table/T5/]
# '''<span style="color:#ff0000">BCG-intolerant</span>'''
#* '''Disease persistence as a result of inability to receive adequate BCG* because of toxicity.''' 
#**Adequate BCG is defined as at least 5-6 weekly instillations of an induction course followed by at least one maintenance cycle (consisting of at least 2 out of 3 weekly BCG treatments) or a second induction cycle (whereby at least 2 of 6 weekly instillations were received).
# '''<span style="color:#ff0000">BCG-relapsing</span>'''
#* '''<span style="color:#ff0000">Recurrence of high-grade disease after achieving a disease-free state at 6 months after adequate BCG.'''
#**Sub-stratified into early (<12 months) vs. intermediate (12-24 months) vs. late (>24 months)
#*** Prognosis improved with increasing duration of disease-free interval
# '''<span style="color:#ff0000">BCG-refractory</span>'''
#* '''<span style="color:#ff0000">Persistent high-grade disease at 6 months despite adequate BCG treatment</span>'''
#*'''<span style="color:#ff0000">Any stage or grade progression by 3 months after the first BCG cycle</span>''' (eg. initial Ta/TaHG or CIS then 3 months BCG then T1HG)
#** BCG-refractory patients are at increased risk of progression and worse 5-year survival rates when compared to patients with a complete response to induction therapy
# '''<span style="color:#ff0000">BCG-unresponsive</span>'''
#*'''<span style="color:#ff0000">Includes</span>''' 
#**'''<span style="color:#ff0000">All BCG refractory tumours</span>'''
#**'''<span style="color:#ff0000">BCG-relapse within 6 months of last BCG exposure</span>'''
#**'''<span style="color:#ff0000">CIS within 12 months of completion of adequate BCG exposure</span>'''
#* BCG-unresponsive disease implies patients being previously treated with adequate BCG (see above)
#* '''Meant to denote a subgroup of patients at highest risk of recurrence and progression for whom additional BCG therapy is not a feasible option.'''

* BCG resistant (described in 2015 CUA NMIBC Guidelines)
** Recurrence or persistence of disease at 3 months after induction cycle but of lesser stage or grade which subsequently is no longer present at 6 months
* Prognosis: BCG intolerance > BCG relapsing > BCG refractory (worst prognosis)
* '''<span style="color:#ff0000">Low-grade recurrences during or after BCG are not considered BCG failure</span>'''