<p><strong> </strong><strong>In intermediate-risk patients who completely respond to induction BCG, clinicians may offer maintenance BCG for 12 months, as tolerated. (<em>Conditional Recommendation; Evidence Level: Grade C</em>)</strong></p>
Discussion
Discussion
<p>Approximately 70% of patients receiving BCG complain of side effects with 8% of these being severe enough to discontinue treatment.<sup>232</sup><sup> </sup>The toxicity of long-term maintenance and the lack of high-quality studies to support the value of more prolonged maintenance over a re-induction course at the time of relapse have led some to question the routine use of a three-year maintenance program,<sup>233</sup><sup> </sup>especially in lower risk patients. In a subgroup analysis of EORTC-30962, 3 years of full-dose maintenance was not superior to 1 year of full-dose maintenance (HR: 0.88; 95% CI: 0.64 to 1.21; p=0.4380)<sup>213</sup><sup> </sup>in an intermediate-risk group (as defined by a progression-risk score of ≤6 and a recurrence score of ≤9 using the EORTC risk calculator).<sup>37</sup> Given the data from meta-analyses supporting the need for maintenance therapy with the data from EORTC-30962 suggesting that a more prolonged maintenance is not necessary, the Panel supports 1 year of maintenance therapy in patients with intermediate-risk NMIBC who have responded to an induction course of BCG.</p>