BCG failed... whats next?

Thanks for the feedback.  That helped. 

The plan is to do another surgery in 2-4 weeks to confirm margins and then another round of chemo but this time with  Gemcitabine+Docetaxel and go from there.  I like the plan.  Not rushing into anything. 

Hi Shepman,

Until recently, there were no drug/treatment available for those tumors which did not respond to BCG treatment.  There was one FDA approved drug Valrubicin, but it was approve over 20 years ago and efficacy was not so good, so I do not think it is being offered.   Often single chemotherapy drug such as mitomycin, gemcitabine was used for BCG unresponsive.  But now there are four FDA drugs are available for BCG unresponsive, and several drug/treatment are in later phase of clinical trial.

Pembrolizumab (Keytruda) alone                Checkpoint Inhibitor                Intravenous              FDA approved 

Gemcitabine+Docetaxel   Existing drugs    Intravesical               Did not require FDA approval

Nadofaragene (Adstiladrin)                          Gene Therapy Secreting IFN   Intravesical               FDA approved   

Anctiva + BCG                                                 IL15 Superagonist  +BCG          Intravesical               FDA approved   


Still on clinical trial   

TLD-1433                         Photodynamic Therapy            Intravesical+Laser  Phase 2B                


TAR-200                          Device to secrete chemo            Intravesical               Phase 2                 

Cretostimogene             Oncolytic Immunotherapy      Intravesical               Phase 3                      
Cretosmitogene + Pembro  Oncolytic Immunotherapy   Intravesical/Intravenous   Phase 2     

Pembrolizumab +BCG  BCG+ immunotherapy          Intravesical/Intravenous Phase 3       

Diagnosed Summer 2023.   Had 2 surgeries to remove tumors. Then had 6 weeks of BCG.  Then off a bit.  Then 3 weeks of BCG.  Had a scope and the doctor didn't like a few spots.  Just had 3rd surgery to biopsy the spots.  2 of 3 came back with my hi-grade cancer.  I get the catheter out tomorrow.  

My team of urologists are chatting this week but I think they are leaning toward removing the entire bladder.  Good move?  I'm only 55.  Get a second opinion?  Other options people have tried?