BCG-Unresponsive Bladder Cancer: New Frontiers in the Treatment Landscape

Abstract

This Ferring-organised Meet-The-Expert symposium at the European Society of Medical Oncology (ESMO) 2019 meeting aimed to discuss new treatment modalities in the management of high-risk, non-muscle invasive bladder cancer (NMIBC). The chairperson Prof Palou commenced the session by discussing the need for newer interventions to address the failure of bacillus Calmette–Guérin (BCG), the first-line treatment against NMIBC, in a substantial proportion of patients. Prof Palou emphasised the need to clearly define refractory disease to optimise second-line treatments, before introducing immune checkpoint inhibitors as a promising class of drug for the treatment of BCG-unresponsive NMIBC. Prof Shariat discussed a case study to define key clinical timepoints for evaluating therapeutic outcomes of BCG treatment. He further outlined factors to be considered before deciding on radical cystectomy in BCG-unresponsive NMIBC. Prof Babjuk listed some of the landmark trials conducted recently to investigate chemotherapeutic agents such as mitomycin C (MMC) and docetaxel in BCG-unresponsive patients before highlighting the role of advanced drug delivery technologies such as electromotive drug administration (EMDA), hyperthermic intravesical chemotherapy, and radiofrequency-induced thermo-chemotherapy effect (RITE) in improving the effectiveness of these agents. Prof Powles shared data from some of the trials investigating immune checkpoint inhibitors such as PURE-01, ABACUS, KEYNOTE, to underscore the importance of biomarkers in selecting appropriate treatment strategies for NMIBC.