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Below is a posted on April 26 in BCAN Forum re BCG shortage in USA. How are we doing in Canada?
I have been treated with BGC for 2 &1/2 years with great success. The doctor at my hospital told me that they have no BCG and have no expected delivery date. I am scheduled for 3 rounds of BCG starting 5/1/19. He told me that he will be instilling ‘Gemzar” in lieu of BCG. Has anyone used this? I’m a little nervous about it’s effectiveness compared to BCG. He said other doctors are waiting for the supply to catch up and taking a wait and see approach. Thankfully my Doctor is not standing by waiting. The diagnosis was T1hg and so far all good. Any thoughts about the Gemzar?
Joe
Yes there is a shortage in Canada!
TO: Physicians Prescribing Treatment for Non-muscle Invasive Bladder Cancer (NMIBC)
RE: Approach for Consideration to Address Shortage of Bacillus Calmette-Guérin (BCG)
Merck (the sole supplier of BCG to Canada) has informed us that there will be a Bacillus Calmette-Guérin (BCG) shortage (Oncotice) in Canada. Given this news, it is recommended that treatment facilities continue to closely monitor the BCG supply on hand.
Conservation strategies to increase the pool of patients that can access BCG and provide alternatives if BCG is not available at all may be considered.While the shortage of BCG is ongoing, the Medical Advisory Board of Bladder Cancer Canada and the CUA Guidelines Committee have reviewed and support the following suggestions:
1. Intravesical chemotherapy should be used as first-line option for intermediate-risk NMIBC. All patients with multirecurrent/multifocal low-grade Ta lesions should receive mitomycin, gemcitabine or epirubicin instead of BCG.
2. If BCG is administered as second-line for intermediate-risk NMIBC, we suggest administering 1/3 dose of BCG (+/- interferon) instead of full dose BCG to triple the pool of patients that can get BCG. This requires treating multiple patients on the same day with the reduced dosage to avoid drug wastage. Maintenance BCG for intermediate-risk patients can be omitted.
3. For high-risk NMIBC, consider 1/3 dose BCG for both induction and maintenance BCG. Maintenance BCG can be shortened to one year (instead of 3 years) for ‘low tier’ high-risk tumors (TaHG tumors).
4. If BCG is not available at all in your center, preferable alternatives to BCG include electromotive mitomycin (EMDA-MMC) or standard mitomycin (induction and maintenance up to one year). Other options such as gemcitabine, epirubicin or sequential gemcitabine/docetaxel may also be considered.
5. Consideration for upfront radical cystectomy as an option in patients with very high-risk disease (T1HG with additional risk factors such as concomitant CIS, lymphovascular invasion or micropapillary features) who are not willing to take any potential oncologic risks with alternative intravesical agents. Sincerely,Wassim Kassouf, MD, CM, FRCSC Chair, BCC Medical Advisory Board Member, Canadian Urological Association Guidelines Committee
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