When BCG doesn't work, what are the treatment options?

@openloc1949, you're quite right that people often choose a medical career because they want to cure and fix what ails us. Luckily more and more students are trained in the emotional side of caring. Like you mention, palliative care is an entire discipline of medicine focused on comfort care and quality of life whether or not condition can be cured.

@mariajosefinamouka, palliative care may be something you wish to ask about for your father along with treatment options, especially is he is dealing with severe side effects.

Here's more information from Mayo Clinic:
- Palliative care https://www.mayoclinic.org/tests-procedures/palliative-care/about/pac-20384637

As others have mentioned, when bladder cancer does not respond to BCG treatment, there are still several treatment options available to explore. When BCG doesn’t work, your father's cancer team will consider different factors like how aggressive the cancer is and your dad's overall health.

Surgery or newer, effective therapies may be available for your dad, like immunotherapy, gene therapy, or intravesical chemotherapy. As @dmr44 mentioned, he may qualify to participate in clinical trials that test promising drugs.

How many BCG treatments did your father have? Have you and your father talked with his cancer team to discuss next steps?

@colleenyoung thanks for your reply. My father has had 10 BCG shots so far. He feels the treatment is working but the side effects are getting worse as time goes by.

Alternatives to BCG; my stage is intermediate. Does GEM/DOCE work?
My stage is intermediate with two surgeries to remove tumors, both noninvasive intermediate. I refused BCG after the first surgery, but am now taking it—6 times, then boosters for 3 times every 3 months—for the rest of my life according to my doctor. Is there a better medication? I’m wondering about alternatives?

@jaxfl
Does GEM/DOCE work better than BCG?

It is complicated.
https://pubmed.ncbi.nlm.nih.gov/39306526/
BCG appears more effective but then again some are refractory to BCG.
https://www.urotoday.com/index.php.
That is why there are now additional alternatives. Check out my other posts.

Life long BCG is not a thing.
https://www.greaterbostonurology.com/blog/what-is-bcg-treatment-for-bladder-cancer).
DOCE/GEM is a very common, and increasingly a more popular alternative.

Efficacy is similar but it is complicated. BCG (live bacterium) is prone to shortages. DOCE/GEM (chemicals) is not.
https://www.urotoday.com/index.php.
There are additional new treatments. However, it takes the medical guidelines and insurance months to years to catch up. And the newer treatments are usually prohibitively expensive.