Managing BCG-Unresponsive Non–Muscle-Invasive Bladder Cancer (NMIBC): Clinical and Operational Perspectives

Katie S. Murray, DO, provides an overview of BCG-unresponsive non–muscle-invasive bladder cancer (NMIBC), defining it as a form of bladder cancer that does not respond to BCG therapy and explaining how it differs from BCG-responsive NMIBC in terms of treatment outcomes and disease progression.

Katie S. Murray, DO, discusses why some patients do not respond to BCG therapy, exploring factors such as tumor biology and immune system dysfunction, and how this impacts their prognosis, while also addressing the challenges and unmet needs in treating these patients, including the current BCG shortages and how it is reshaping treatment approaches.

Katie S. Murray, DO, reviews the standard treatment options for BCG-unresponsive non–muscle-invasive bladder cancer (NMIBC), including intravesical chemotherapy, PD-L1 inhibitors, and other immunotherapeutic agents while highlighting the limitations of these therapies, such as incomplete response rates and potential adverse effects.

Katie S. Murray, DO, discusses how the introduction of targeted gene therapies has shifted the approach to managing BCG-unresponsive non–muscle-invasive bladder cancer (NMIBC), offering more personalized treatment options, and explains how the ease of administration—without the need for specialized equipment like biosafety hoods—reduces logistical burdens on clinics.

Katie S. Murray, DO, emphasizes the importance of administering newer treatments for BCG-unresponsive non–muscle-invasive bladder cancer (NMIBC) locally by urologists, which helps reduce the overall burden on patients, minimizes systemic adverse effects, and eliminates the need for travel to specialized oncology centers, while also recommending strategies to encourage health care providers to adopt these treatments, including education on clinical trial data and real-world efficacy.

Katie S. Murray, DO, discusses the promising clinical trial data showing that over 50% of patients with BCG-unresponsive non–muscle-invasive bladder cancer (NMIBC) experience a complete response after 3 months of treatment, comparing these outcomes with her own clinical experience, and highlights the importance of long-term follow-up to assess the durability of response in patients receiving newer therapies.