What is your preferred intravesical therapy for recurrent high-grade non-muscle-invasive bladder cancer when BCG is unavailable?

If BCG is not available in standard dosing due to shortage, there are some options. First, split dosing of BCG can still be effective and have lower toxicity, so that can be considered. The SWOG study compared TICE vs Tokyo strain, and it was non-inferior, so there is hope this would be on the horizon to help our BCG shortage. When there is no hope of getting BCG, patients can get gemcitabine and docetaxel sequential intravesical treatment. There has been retrospective data from Iowa and now Mt Sinai showing that, for first-line treatment, this is very effective. There is an ECOG trial (BRIDGE) comparing BCG and gemcitabine and docetaxel based on the Iowa experience with improved recurrence-free survival.

IL-15 superagonist and the viral vec...