Homepage – Forum › Forums › Non-Muscle Invasive Bladder Cancer › Limited Supply Of BCG
- This topic has 7 replies, 5 voices, and was last updated 5 years, 8 months ago by
AndreaG.
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November 12, 2018 at 4:23 pm #32909
Jack Moon
KeymasterBladder Cancer Canada and its Medical Advisory Board have been advised by Merck Canada that they will be experiencing limited supply of Bacillus Calmette-Guerin (BCG) in the coming months.
Merck has established an allocation plan effective immediately and will keep information updated at https://www.drugshortagescanada.ca/drug/4066
Merck expects to fulfill between 75% and 100% of the normal demand during this time. Allocation based on historical customer orders has been implemented to ensure the available quantity is efficiently provided to patients. The anticipated end date is October 2019.
Below is an approach for consideration by physicians who treat bladder cancer to address the shortage of BCG should limited supply be realized.
Download the document here: Approach to Address BCG Shortage (Nov 2018)
The Medical Advisory Board of Bladder Cancer Canada and the CUA Guidelines Committee have reviewed and support these suggestions.
Bladder Cancer Canada will continue to update you as we receive more information.-
This topic was modified 6 years, 3 months ago by
Jack Moon.
November 12, 2018 at 4:26 pm #32910Jack Moon
KeymasterHERE IS THE DOWNLOAD FROM ABOVE
November 8, 2018TO: 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
November 13, 2018 at 4:11 pm #32923marysue
ParticipantOMG! Here we go again. Is there any way to end these shortages??? This is so unfair to patients.
November 16, 2018 at 12:51 pm #32953rob1234
Participanti (personally) have only recently been diagnosed. dec 5th they will be going in for a cystobiopsy. i am told that this is the second look after the turbt on oct 10th. it is to see if anything has come back and to make absolutely sure there has been no muscle involvement. the doctor says (very well experienced) that he doesnt think it has penetrated any muscle.
i had been cautiously optimistic as he said assuming an all clear, it was going to be BCG. now i get this letter with strange things like 1/3 doses,etc. i am not willing to take the chances. the other drugs (if no bcg) arent as good (i am told). therefore, i will be asking for radical cystectomy. i know they take other goodies too but i am willing to put up with any side effects.
this is a rather “icky” turn of events. ostomy, here i come
dont mean to be a downer and apologize
rob stull
November 17, 2018 at 7:33 am #32959Lou
ParticipantHi rob1234,
I’m trying to avoid cystecomy, but have very harsh reactions to BCG. My last BCG treatment (#9 this year) was Tuesday and it was a disaster–could only hold it 40 minutes, bled like a pig, came home with a foley catheter (btw, are foley catheters supposed to hurt 24×7?). (I should have stayed home).
It’s probably wishful thinking on my part, but there is a Phase II Clinical trial due to start shortly following a smashingly successful Phase Ib (NCT03053635) where they amazingly ended up curing the very first two patients treated with full therapeutic dose–each after only one treatment. Imagine that–1 treatment instead on the 12 treatments BCG requires in the same time frame. Patient one is cancer free now at nine months, and the second is cancer free at six months (will be checked in a few weeks for nine months). This has to be the most smashingly successful Phase I NMIBC Clinical trial ever! On top of that, it doesn’t use a drop of BCG.
I read you have 1.5 to 2 years after diagnosis to safely explore other options before going the RC route. That gives me through September 2019 to look around. Hopefully the sun will come out before then, and this new treatment will be available at least via clinical trial.
Regards,
LouNovember 17, 2018 at 9:25 am #32960Jack Moon
KeymasterLatest Update on Trial Posted by Sun on Nov 8/18
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This reply was modified 6 years, 3 months ago by
Jack Moon.
March 11, 2019 at 2:54 pm #34663Jack Moon
KeymasterUpdate regarding BCG shortage.
Jack
May 29, 2019 at 10:57 am #35645AndreaG
ParticipantFirst time poster here! I started my first BCG treatment 3 weeks ago for low grade non invasive papillary carcinoma, after two TURBTs and one recurrence. My third treatment is tomorrow and my urologist just advised me of the shortage. Hoping that 3 out of 6 is better than nothing??
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This topic was modified 6 years, 3 months ago by
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