December 17, 2021
To: Physicians Prescribing Treatment for Nonmuscle Invasive Bladder Cancer (NMIBC)
- Until 2021, TICE BCG was the only strain available in Canada
- A second strain of BCG recently received conditional approval by Health Canada in 2021 and is available in the Canadian market: VERITY-BCG(TM)
- The past shortage of BCG is therefore resolved.
The Medical Advisory Board of Bladder Cancer Canada, with endorsement by the Canadian Urological Association (2021), has reviewed and support the following suggestions:
- Every patient in need of BCG therapy should receive full dose BCG as per CUA guidelines(1).
- Patients with high risk NMIBC should receive full dose BCG for 6 weeks of induction and 3 years of maintenance therapy.
- When BCG is administered to patients with intermediate risk NMIBC, full dose BCG for 6 weeks of induction and 1 year of maintenance therapy is recommended.
- Patients should ideally receive all treatments with a single strain of BCG. However, if supply of one BCG strain is limited, patients should be switched to the other strain if necessary to ensure full dose BCG is administered for the recommended duration of maintenance therapy.
- VERITY BCG is not approved by Health Canada for the treatment of CIS and its use should be limited to papillary NMIBC (Ta/T1) without evidence of CIS. Specifically: “Verity-BCG is indicated as an adjuvant therapy after transurethral resection (TUR) of a primary or relapsing superficial papillary urothelial cell carcinoma of the bladder stage Ta (grade 2 or 3) or T1 (grade 1, 2, or 3), without concomitant carcinoma in situ. It is only recommended for stage Ta grade 1 papillary tumors, when there is judged to be a high risk (>50%) of tumor recurrence.”
Dr. Peter Black, MD, FRCSC, Chair, BCC Medical Advisory Board
Dr. Wassim Kassouf, MD, CM, FRCSC, Past Chair, BCC Medical Advisory Board, CUA Treasurer
Dr. Girish Kulkarni, MD, PHD, FRCSC, Vice Chair, BCC Medical Advisory Board Chair, CUA Continuing Professional Development Committee