Volume 10, Number 4Review ArticlesBacillus Calmette-Guérin Failures and Beyond: Contemporary Management of Non–Muscle-Invasive Bladder CancerManagement ReviewMichael S CooksonRichard E GreenbergH Barton GrossmanThomas E KeaneMichael A O'DonnellIn the United States, bacillus Calmette-Guérin (BCG) is the treatment most used for superficial bladder cancer. Patients with carcinoma in situ (CIS) treated with intravesical BCG plus interferon have a 60% to 70% chance of a complete and durable response if they were never treated with BCG or if they failed only 1 prior induction or relapsed more than a year from induction. Intravesical gemcitabine is safe, but its usefulness for BCG-refractory patients is unclear. Valrubicin, approved for intravesical treatment of BCGrefractory CIS of the bladder, has efficacy and acceptable toxicity. Cystectomy should be considered in high-risk, non–muscle-invasive cancer, particularly if intravesical therapy failed. [Rev Urol. 2008;10(4):281-289]Bacillus Calmette-GuérinBladder cancerCystectomyGemcitabine