Current Standards of Care and Shifting Strategies in NMIBC

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EP: 1.Current Standards of Care and Shifting Strategies in NMIBC

EP: 2.NMIBC Treatment Decisions in the Age of BCG Shortages

EP: 3.Expert Discussion on BCG-Unresponsive NMIBC

EP: 4.Bladder-Sparing Breakthroughs: Novel FDA-Approved Treatment Options for NMIBC

EP: 5.Weighing the Risks and Benefits of Bladder-Sparing Agents vs Cystectomy

EP: 6.What’s Next for NMIBC: The Immunotherapy and Gene Therapy Pipeline

EP: 7.Topline Data From the BOND-003 Trial in NMIBC

EP: 8.Immunotherapy in NMIBC: Key Results Safety Profile From BOND-003 Trial

The current standard of care for non–muscle-invasive bladder cancer (NMIBC) is highly dependent on risk stratification. Low-risk patients, typically with solitary, low-grade tumors, are mainly managed through active cystoscopic surveillance. Intermediate-risk patients, often presenting with larger or recurrent low-grade tumors, are treated with intravesical chemotherapy, predominantly gemcitabine in the US, or with BCG depending on its availability. High-risk patients, including those with high-grade, multifocal, or T1 tumors, are traditionally treated with BCG, though shortages have led to alternatives like the gemcitabine-docetaxel (gem-doce) combination, pending further data from the BRIDGE trial.

Resource availability significantly affects treatment choices, particularly regarding BCG. In light of the shortage, clinicians often redirect high-volume, low-grade cases toward chemotherapy and reserve BCG for low-volume, high-grade cases, as guidelines allow. While BCG remains the preferred standard for high-risk NMIBC, the potential for gem-doce to become a co-standard hinges on forthcoming trial outcomes. As the therapeutic landscape evolves, clinicians are seeking more clarity on the most effective strategies, especially as new drugs and combinations emerge.

Major challenges in managing high-risk NMIBC include the lack of durable responses in BCG-unresponsive cases and the difficulty in identifying which patients will benefit from specific therapies. Experts emphasize the need for improved treatment sequencing and better patient selection tools, with particular interest in developing robust biomarkers and artificial intelligence–driven predictive models. These tools could enable more personalized and effective treatment approaches, minimizing delays in moving patients to radical cystectomy when appropriate. Ongoing research and trials, including those utilizing biomarkers like VESTA, are seen as crucial steps toward refining risk stratification and improving clinical outcomes.