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

Overview of BCG-Unresponsive NMIBC

Would you please start by giving a brief overview of BCG-unresponsive NMIBC?

How does it differ from NMIBC that responds to BCG treatment?

Videos

Katie S. Murray, DO, discusses how advancements in targeted gene therapies and immunotherapeutic options are transforming the management of BCG-unresponsive non–muscle-invasive bladder cancer (NMIBC), offering urologists more effective, accessible treatment alternatives and reducing patient burden.

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.

Challenges of BCG-Unresponsive NMIBC

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.

Standard Treatment Options for BCG-Unresponsive NMIBC

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.

Unresponsive NMIBC: Gene Therapies

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.

Gene Therapy Considerations for BCG-Unresponsive NMIBC

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.

Gene Therapy Data for BCG-Unresponsive NMIBC

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.

BCG-Unresponsive NMIBC: Insights for Newer Treatment Modalities

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.

Addressing Challenges in BCG-Unresponsive NMIBC: Overview and Unmet Needs

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.

Current Treatment Options for BCG-Unresponsive NMIBC

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

The Impact of Targeted Gene Therapy and Nadofaragene Firadenovec on BCG-Unresponsive NMIBC

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.

Advancements in BCG-Unresponsive NMIBC and the Impact of Trial Results and Long-Term Follow-Up

BCG-unresponsive non-muscle invasive bladder cancer (NMIBC) is characterized by the failure to achieve a complete response or recurrence after adequate BCG therapy. This condition is defined by persistent or recurrent high-grade tumors or carcinoma in situ within six months of BCG treatment, or recurrence after achieving a complete response within 12 months. It differs from BCG-responsive NMIBC, where patients achieve and maintain a complete response following BCG therapy. BCG-unresponsive NMIBC poses a significant clinical challenge, often necessitating alternative therapeutic strategies or radical cystectomy.

Overview of BCG-Unresponsive NMIBC

Key Takeaways

EP: 1.Overview of BCG-Unresponsive NMIBC

EP: 2.Challenges of BCG-Unresponsive NMIBC

EP: 3.Standard Treatment Options for BCG-Unresponsive NMIBC

EP: 4.Unresponsive NMIBC: Gene Therapies

EP: 5.Gene Therapy Considerations for BCG-Unresponsive NMIBC

EP: 6.Gene Therapy Data for BCG-Unresponsive NMIBC

EP: 7.BCG-Unresponsive NMIBC: Insights for Newer Treatment Modalities

EP: 8.Addressing Challenges in BCG-Unresponsive NMIBC: Overview and Unmet Needs

EP: 9.Current Treatment Options for BCG-Unresponsive NMIBC

EP: 10.The Impact of Targeted Gene Therapy and Nadofaragene Firadenovec on BCG-Unresponsive NMIBC

EP: 11.Advancements in BCG-Unresponsive NMIBC and the Impact of Trial Results and Long-Term Follow-Up