Novel Therapies for High-Risk Non-Muscle Invasive Bladder Cancer

Abstract

Purpose of Review The treatment options for high-risk non-muscle invasive bladder cancer (NMIBC), particularly following BCG, remain limited. We highlight recent, promising therapies for high-risk NMIBC. Recent Findings Several therapies utilizing different mechanisms of action have demonstrated favorable results in the BCG-naïve and BCG-unresponsive settings. These treatments include intravenous and intravesical immunotherapy, viral- and bacterial-based intravesical therapies, combination intravesical chemotherapy regimens, and novel intravesical chemotherapy administration. Overall, the efficacy and tolerability of emerging treatments for NMIBC appear promising and provide potential alternatives to radical cystectomy. Summary As the landscape of managing BCG-unresponsive disease evolves, clinical trials will explore future options and determine effective alternatives.

Bladder cancer

“…17,21,22 Approximately 70% of cases are NMIBC. 17,21,22 The procedure may also include Bladder cancer risk factors [5][6][7][8][9]…”

“…Patients may experience urinary urgency and burning, mild fatigue, and fever for a few days after receiving BCG. 17,21,22 Most patients also receive intravesical chemotherapy with mitomycin or gemcitabine to initiate apoptotic cell death, destroying the tumor. 17,21,22 The most common adverse reactions from intravesical chemotherapy are a burning sensation in the bladder and hematuria.…”

“…Partial cystectomy may be considered in Stage II with a normally functioning bladder and a small solitary tumor. 17,21,23 After the procedure, the patient will urinate more often. Unfortunately, cancer is likely to recur after a partial cystectomy.…”

“…21,24 RT may be used with surgery, chemotherapy, immunotherapy, and targeted therapy. 21,24 RT may cause redness and peeling of the skin, anemia, easy bruising and bleeding, fatigue, burning or painful urination, and sexual dysfunction. 21,24 Treatment: Stage IV Bladder cancer reaches Stage IV after it has penetrated the abdominal or pelvic walls and may involve lymph nodes or spread to other parts of the body and is difficult to eradicate.…”

“…21,24 RT may cause redness and peeling of the skin, anemia, easy bruising and bleeding, fatigue, burning or painful urination, and sexual dysfunction. 21,24 Treatment: Stage IV Bladder cancer reaches Stage IV after it has penetrated the abdominal or pelvic walls and may involve lymph nodes or spread to other parts of the body and is difficult to eradicate. 18,19 Cisplatin combined with either methotrexate, vinblastine, doxorubicin, or methotrexate and vinblastine is a standard first-line systemic chemotherapy protocol.…”