Thirty to forty percent of patients with high grade nonmuscle invasive bladder cancer (NMIBC) fail to respond to intravesical therapy with bacillus Calmette-Guerin (BCG). Interferon-α2B plus BCG has been shown to be effective in a subset of patients with NMIBC BCG refractory disease (Correa et al. 2015). Correa et al. (2015) reviewed a contemporary series on the effectiveness and safety of intravesical BCG plus interferon-α2B therapy in patients with BCG refractory NMIBC . High risk disease was found in 88.6% of patients at induction. The 12-month and 24-month recurrence-free survival were 38.6% and 18.2%, respectively. 25 (56.8%) ultimately had disease recurrence. Radical cystectomy was performed in 16 (36.4%) patients.

It is advocated that patients with high-risk non-muscle-invasive bladder cancer (NMIBC) receive an adjuvant course of intravesical Bacille Calmette-Guerin (BCG) as first-line treatment (Yates and Rouprêt 2011). However, a substantial proportion of patients will ‘fail’ BCG, either early with persistent (refractory) disease or recur late after a long disease-free interval (relapsing) (Yates and Rouprêt 2011). Guideline recommendation in the ‘refractory’ setting is radical cystectomy, but there are situations when extirpative surgery is not feasible due to competing co-morbidity, a patient’s desire for bladder preservation or reluctance to undergo surgery. These options can be categorised as immunotherapy, chemotherapy, device-assisted therapy and combination therapy (Yates and Rouprêt 2011). However, data is lacking from trials.