NON-MUSCLE INVASIVE BLADDER CANCER: Edited by Ashish M. Kamat and Paolo GonteroWhat to do during Bacillus Calmette–Guérin shortage? Valid strategies based on evidenceAbufaraj, Mohammada,b; Mostafid, Hughc; Shariat, Shahrokh F.a,d,e,f; Babjuk, Marekc,gAuthor Information aDepartment of Urology, Medical University of Vienna, Vienna, Austria bDivision of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan cDepartment of Urology, Royal Surrey County Hospital, Guildford, UK dKarl Landsteiner Institute of Urology and Andrology, Vienna, Austria eDepartment of Urology, University of Texas Southwestern Medical Center, Dallas, Texas fDepartment of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York, USA gDepartment of Urology, Motol Hospital, Second Faculty of Medicine, Charles; University of Prague, Prague, Czech Republic Correspondence to Shahrokh F. Shariat, MD, Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria. Tel: +43 1 40400 2615; fax: +43 1 40400 2332; e-mail: [email protected] Current Opinion in Urology: November 2018 - Volume 28 - Issue 6 - p 570-576 doi: 10.1097/MOU.0000000000000544 Buy Metrics Abstract Purpose of review Over the last decade, the world has experienced health-threatening supply shortages of Bacillus Calmette–Guérin (BCG) immunotherapy for nonmuscle-invasive bladder cancer (NMIBC). We summarize the current literature to assist in treatment decisions in light of suboptimal supply. Recent findings Currently available data do not support a superiority of one BCG strain over the other. Intravesical chemotherapy seems to provide similar results in term of disease progression but not recurrence in intermediate-risk patients. One trial has shown that a 3-year maintenance course of BCG in high-risk NMIBC has no advantage in term of progression or overall survival in comparison with 1-year maintenance. Synergo radiofrequency-induced hyperthermia is a reliable alternative in intermediate or high-risk NMIBC with at least similar recurrence rates compared with BCG. Summary Patients with intermediate-risk NMIBC can be offered multiple instillations of intravesical chemotherapy for up to 12 months. In high-risk patients and in case of BCG shortage, BCG instillations can be terminated when the patient has completed 1 year of maintenance. Mitomycin C is an alternative in lowest risk high-risk (G3Ta) NMIBC, whereas patients with pT1/carcinoma in situ can be offered Synergo with mitomycin C when radical cystectomy is not feasible. Immediate radical cystectomy should always be considered in highest risk NMIBC after weighing up benefit to risk. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.