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We would like to commend Steinberg et al. on their efforts to develop a data-driven sub-classification for an increasingly accepted disease state of non-muscle invasive bladder cancer – i.e. BCG unresponsive disease. The authors used data collected in the Phase II BCG-Interferon-2B trial originally published in 2006 [1] and performed subset analyses on the outcomes of patients who underwent additional intravesical therapy (in this case, combination BCG/IFN therapy) [2]. Factors assessed included age, gender, number of prior BCG courses, BCG failure interval, BCG strain, number of prior TURBT’s, and tumor size. Notably, most patients did not receive maintenance BCG, since the trial was initiated prior to acceptance of this as standard of care. Based on their analysis, for patients with CIS, the highest risk group was found to be those who had ≥2 episodes of BCG failure and disease-free interval of <12 months from BCG treatment (estimated RFS 14% at 24 months). For those with papillary tumors, risk factors for failure included ≥2 episodes of prior BCG

bladder cancer

Letter to the Editor: Bacillus Calmette-Guerin (BCG) Treatment Failures with Non-Muscle Invasive Bladder Cancer: A Data-Driven Definition for BCG Unresponsive Disease