Disease States / Non-muscle-invasive Bladder Cancer

TREATMENT LANDSCAPE EVOLUTIONS

Non-muscle-invasive Bladder Cancer

Non-muscle-invasive bladder cancer (NMIBC) accounts for about 75% of all bladder cancers. The mainstay of treatment for NMIBC is transurethral resection (TURBT) followed by intravesical BCG (Bacillus Calmette-Guérin) therapy for intermediate- and high-risk patients. Intravesical chemotherapy is an alternative to induction BCG. Although rates of NMIBC progression are relatively low, recurrence rates are high. Thus, patients must undergo frequent cystoscopic surveillance, and many patients require repeated resections and multiple rounds of intravesical therapy. Radical cystectomy is considered the gold standard for patients who do not respond to BCG therapy, though many patients prefer bladder-sparing options, and there are currently 3 FDA-approved, non-chemotherapy, options in this setting. Ongoing shortages of BCG have further stimulated research to find alternative therapies. Recent and ongoing trials are exploring innovative drug delivery systems as well as novel drug therapies for low-risk disease, as alternatives to BCG therapy for treatment-naïve patients with intermediate- and high-risk disease, and as treatments for BCG-unresponsive disease^1,2. Research is also continuing toward the development of urinary biomarkers with adequate sensitivity and specificity to allow their use in place of cytoscopic surveillance. Finally, additional methods for excision of NMIBC are emerging, including several methods for en bloc transurethral resection³ and holmium laser transurethral resection⁴.