Novel anticancer therapy in BCG unresponsive non-muscle-invasive bladder cancer

ABSTRACT

Introduction

Many patients with non-muscle-invasive bladder cancer (NMIBC) failed intravesical BCG therapy. Currently, radical cystectomy is the recommended standard of care for those patients. There is unfortunately no effective other second-line therapy recommended.

Areas covered

In this review, we present the topics of BCG unresponsive NMIBC; definition, prognosis, and further treatment options: immunotherapy, intravesical chemotherapy, gene therapy, and targeted individualized therapy.

Expert opinion

There are major challenges of the management of NMIBC who failed BCG therapy as many patients refuse or are unfit for radical cystectomy. Multiple new modalities currently under investigation in ongoing clinical trials to better treat this category of patients. Immunotherapy, especially PD-1/PD-L1 inhibitors, offers exciting and potentially effective strategies for the treatment of BCG unresponsive NMIBC. As the data expands, it is sure that soon there will be established new guidelines for NMIBC.

KEYWORDS:

• Bladder cancer
• BCG therapy
• non-muscle invasive
• gene therapy
• immunotherapy
• BCG unresponsive
• targeted therapy
• new therapy

Article highlights

• The mainstay of treatment of patients with intermediate or high-risk NMIBC is intravesical BCG.

• Radical cystectomy remains the gold standard treatment for BCG failure in NMIBC patients.

• There is an urgent need to develop new therapies for patients with NMIBC who failed on BCG.

• New strategies including immunotherapies and other than immunotherapies are developed for patients with NMIBC unresponsive to BCG.

• Intravesical chemotherapy following BCG failure showed promising results in clinical trials.

• Clinical trials testing PD-1/PD-L1 blockade for BCG-unresponsive NMIBC are ongoing.

• Many novel therapies including gene therapy, vaccine therapy, and targeted therapy are being tested for BCG-unresponsive NMIBC patients.

• It is crucial for any urologist to be aware of many alternatives who are tested for BCG-unresponsive NMIBC.

Declaration of interest

The 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.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper received no funding.