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Evaluating Alternatives to BCG: Is Combination Chemotherapy the Next Frontier?

Evaluating Alternatives to BCG: Is Combination Chemotherapy the Next Frontier?

Maintenance dosing of intravesical combination chemotherapy “leads to more durable responses than induction treatment alone.”

If you are diagnosed with early-stage bladder cancer, you will probably be given a locally delivered immunotherapy called BCG. Soon, there may be other options, as well. Previously, Brady scientists Max Kates, M.D., and Trinity Bivalacqua, M.D., Ph.D., showed that BCG’s success is largely due to an influx of T cells into bladder tumors. “A single supplier in the United States is currently unable to meet demand for the treatment” notes Kates. “However, BCG is not the only effective treatment for this disease.”

Over the past five years, and with the help of collaborators from the Center for Nanomedicine at Johns Hopkins, Kates and his colleagues have designed novel chemotherapy approaches to enhance drug absorption into the bladder wall. Following the lead of colleagues from the University of Iowa, the team has begun to offer intravesical combination chemotherapy, including gemcitabine/ docetaxel, for patients who do not have access to or are not candidates for BCG.

Recent work by Kates and colleagues has shown that “maintenance dosing of this combination leads to more durable responses than induction treatment alone,” he says. “We are in the midst of a new wave of interest in combination intravesical chemotherapy for bladder cancer. Our current efforts are focused on sequencing these tumors to identify predictors of response to these new and exciting therapies.” For these discoveries, the American Cancer Society has given Kates’s lab a five-year Clinical Scientist Development Award. This work was published in Clinical Cancer Research and Cancer Immunological Research.

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