Michael A. O’Donnell, MD, presented “High-Risk/BCG Naïve: Treatment of Choice” at the 7th International Bladder Cancer Update on December 6, 2024, in Dallas, Texas.
How to cite: O’Donnell, Michael A. “High-Risk/BCG Naïve: Treatment of Choice.” December 2024. Accessed Apr 2025. https://grandroundsinurology.com/high-risk-bcg-naive-treatment-of-choice/
High-Risk/BCG Naïve: Treatment of Choice – Summary
Michael A. O’Donnell, MD, discusses BCG’s role as the standard treatment for non-muscle invasive bladder cancer (NMIBC), emphasizing its global acceptance and long-term efficacy.
In this 20-minute presentation, Dr. O’Donnell stresses that a persistent BCG shortage has necessitated the exploration of alternative therapies, including gemcitabine-docetaxel (Gem/Doce), which has become a de facto standard in the shortage era. Retrospective data comparing Gem/Doce to BCG demonstrate comparable recurrence-free and progression-free survival, with lower toxicity and improved patient quality of life. A biomarker analysis suggests that BCG and Gem/Doce may target different patient populations, potentially affecting personalized treatment selection.
The forum’s experts enter the discussion, addressing the potential of immune checkpoint inhibitors in NMIBC, with concerns regarding toxicity, cost, and incremental efficacy over existing treatments. The evolving landscape underscores the need for biomarkers to stratify patients effectively and guide treatment selection.
About the 7th International Bladder Cancer Update:
The International Bladder Cancer Update (IBCU) is a CME conference focused on the diagnosis and treatment of bladder cancer. The conference offers medical professionals an opportunity to listen to updates from, and interact with, expert international faculty to improve knowledge and determine best treatment practices to improve patient outcomes. IBCU encompasses expert lectures, interactive discussions, a panel roundtable, debates, and case presentations. It is physician-led, multi-supported, and designed for urologists, urologic oncologists, and other healthcare professionals involved in the treatment of bladder cancer.
For further educational activities from this conference, visit our collection page.
ABOUT THE AUTHOR
Michael A. O’Donnell, MD, FACS, earned his medical degree from Duke University in Durham, North Carolina. He completed his residency at Harvard Medical School and completed a clinical and research fellowship at the Whitehead Institute and Beth Israel Deaconess Medical Center Dr. O’Donnell is currentlyRichard D. Williams ChairedProfessor of Urology and Director of Urologic Oncology at the University of Iowa, Carver College of Medicine.
Dr. O'Donnell's basic and clinical research has a long history of focusing on bladder immunology and bladder cancer immunotherapy, particularly the anti-cancer mechanisms of bacillus Calmette-Guérin (BCG) and its enhancement with combination therapies. Dr. O'Donnell recently headed a national trial of bladder cancer treatment utilizing BCG plus interferon (a natural protein which induces healthy cells to combat disease) comprising more than 1,000 patients and holds several U.S. patents for his work. Dr. O'Donnell's laboratory and clinical studies seek to determine the exact mechanism by which BCG targets bladder cancer tumor cells and to enhance its efficacy, either alone or in combination with other agents, while reducing its toxicity to healthy cells. Dr. O'Donnell's research efforts also include exploration of methods to detect bladder cancer at earlier stages and new combination topical chemotherapy treatments for early bladder cancer. He has instituted two such methods, including a urinary FISH assay and the NMP-22 Bladder Check test in the urology clinic. He has pioneered several new sequential combination therapies involving adriamycin, gemcitabine, docetaxel, and mitomycin for treating BCG-resistant/recurrent bladder cancers.
