If there were recurrence of high risk NMIBC after min. 5+2 then, then patient is qualified for treatments for BCG Unresponsive which have been approved by FDA or on clinical trials. Of course no recurrence or progression is much preferred. In case of T1HG, if T1HG recurs after the 6 weekly induction course, it is also considered as BCG unresponsive..
Treatment for BCG Unresponsive.
Pembrlizumab (Keytruda) immunotherapy – Intravenous injection. FDA approved in January,2020
Oportuzumab (Vicineum) Phase 3 on pause
Nadofaragene firadenovec (Adstilladrin) – GC0070 Approved in December, 2022
N-803 : IL-15 based Natural Killer cells activating drug Phase 3
GEM+DOC are generic drugs, so it can be used for BCG unresponsive, BCG intolerant and even for BCG naïve.
Gemcitabine/Docetaxel and N-803 look most promising for RFS so far.
I heard from a urologist that if patient can complete the induction + 1st maintenance course, the patient would likely be able to complete the entire BCG treatment (27 treatment in total. So the completion of , 5 + 2 or 6 +3 are good start.
Did your oncologists either at MSK or Moffit suggest prescribing Ofloxacin - fluoroquinolone antibiotics to reduce side effects you are experiencing? Ofloxacin is the only antibiotics which was clinically tested (2006) antibiotic to reduce side effects of BCG treatment. Dr. Ashish Kamat of MD Andersons seems to prescribe Ofloxacin to every BCG treatment. Ofloxacin is orally taken at 6 hours and at 12 hours after BCG instillation. The rationale is that all necessary immune responses are obtained after 6 hours of BCG instillation, so it is okay to kill BCG bacteria which are still in the bladder, also there were no difference in efficacy between Ofloxacin group and placebo group. Below is the link to the article on Ofloxacin.
pubmed.ncbi.nlm.nih.gov/16890660/