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.

Katie S. Murray, DO, offers advice to urologists considering the adoption of newer treatment modalities for BCG-unresponsive non–muscle-invasive bladder cancer (NMIBC), encouraging them to integrate these therapies into practice in light of the positive clinical trial data while emphasizing the potential for improved patient outcomes and the importance of staying informed about evolving treatment options.

Max Kates, MD, discusses how BCG-unresponsive non-muscle invasive bladder cancer patients historically faced limited treatment options beyond radical cystectomy, with significant unmet needs in preserving bladder function while effectively treating this aggressive disease.

A panelist discusses how intravesical chemotherapy offers localized treatment with minimal systemic effects but requires frequent administration, while PD-L1 inhibitors show promising response rates yet come with immune-related adverse events, highlighting how each current treatment option presents distinct trade-offs among efficacy, safety, and convenience.

A panelist discusses how targeted gene therapy, particularly nadofaragene firadenovec, represents a paradigm shift in BCG-unresponsive NMIBC treatment.

Max Kates, MD, discusses how early complete response rates exceeding 50% at 3 months with newer therapies are encouraging, though long-term follow-up remains critical for evaluating durability of response and establishing real-world effectiveness compared with clinical trial outcomes.

A panelist discusses how treatment decisions involve balancing clinical efficacy with financial considerations, noting that patients often prefer treatments with fewer office visits and minimal lifestyle disruption when presented with multiple effective options.

Max Kates, MD, discusses how newer therapies for BCG-unresponsive NMIBC may have better long-term cost-effectiveness despite higher initial costs, emphasizing the importance of leveraging patient assistance programs, copay cards, and foundation support to ensure treatment access while using cost comparison tools to help patients make informed decisions.

A panelist discusses how transitioning to quarterly treatment administration reduces clinic resource strain through decreased staff time and equipment usage, while therapies requiring minimal specialized handling further streamline operations and improve workflow efficiency.

Max Kates, MD, discusses how the ability to deliver newer treatments in local urology clinics rather than specialized centers reduces patient travel burden and improves access to care, while suggesting that increased education about safety profiles and implementation protocols could encourage broader adoption among health care providers.