Tackling non-muscle invasive bladder cancer in the clinic

ABSTRACT

Introduction: Non-muscle invasive bladder cancer (NMIBC) is a common disease process with a high propensity for recurrence and risk of progression to muscle-invasive or systemic disease. Optimal management of NMIBC depends on appropriate resection and staging, risk-based use of intravesical therapy and tailored surveillance. Current challenges include compliance with guideline recommendations and cancers which are refractory to standard therapies.

Areas covered: This review summarizes the conventional management of NMIBC – which relies on strict cystoscopic surveillance and intravesical therapies with chemotherapy and/or immunotherapy in the form of bacillus Calmette-Guerin (BCG). As many patients will be resistant to conventional treatment, investigational therapies and novel prognostic models will also be discussed.

Expert commentary: For decades, the management of NMIBC has been predicated on intravesical therapies, most often through the instillation of BCG which has proven clinical efficacy over transurethral resection alone. Despite this, many patients will recur or progress after BCG therapy. While radical cystectomy remains the standard for such patients, suitable alternatives are being actively investigated. An increased interest in immunotherapy for malignancy has reinvigorated this field and on-going advances in disease prognostication are likely to improve upon the existing treatment paradigms for NMIBC.

KEYWORDS:

• Non-muscle invasive bladder cancer
• intravesical therapy
• BCG
• novel
• chemothermotherapy
• electromotive drug administration

Declaration of interest

Y Lotan is involved in research for Photocure, Abbott Laboratories, Cepheid Inc., Pacific Edge Ltd., GenomeDx Bioscience Inc., FKD Therapies Oy and consults for Photocure, KMD Biomarker Diagnostics, BioCancell Therapeutics Ltd. The other authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

SL Woldu is supported by NIH T32 Ruth L. Kirschstein Institutional National Research Award.