Management of NMIBC during BCG Shortage Era

M. SivashankarSri Lanka Speaker Management of NMIBC during BCG Shortage EraDuring periods of Bacillus Calmette–Guérin (BCG) shortage, management of non muscle invasive bladder cancer (NMIBC) must be guided by risk stratification and resource optimization. Recent evidence supports reduced dosing (one third to half) rather than abbreviated schedules, with induction prioritized for high risk and carcinoma in situ cases. Alternative intravesical agents—mitomycin C (especially with chemohyperthermia or EMDA), gemcitabine, epirubicin, or sequential gemcitabine/docetaxel—are recommended when BCG is unavailable. In cases of incomplete BCG followed by chemotherapy, outcomes may be superior to chemotherapy alone. For high risk patients, upfront radical cystectomy should be considered when BCG is wholly unavailable. Future trials and supply diversification remain vital.