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PEER-TO-PEER CLINICAL CONVERSATIONS |
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Challenges and Management Strategies for BCG-Unresponsive Bladder Cancer
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Patrick Hensley, MD, and Frances Martin, MD
Frances Martin and Patrick Hensley discuss BCG-unresponsive NMIBC challenges with Sam Chang. Strict BCG unresponsive definition requires adequate BCG, but only 37% of patients receive this regimen during shortages.
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CORE-008 Cohort B Evaluates Cretostimogene in BCG-Exposed Non-Muscle Invasive Bladder Cancer
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Trinity Bivalacqua, MD, PhD
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| Trinity Bivalacqua discusses CORE-008 Cohort B, an enrolling trial evaluating cretostimogene in the BCG-exposed NMIBC space. The trial is for patients with persistent or recurrent high-grade disease after adequate BCG induction or those with delayed relapse.
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CISTO Study: Patient Preferences Drive Bladder Cancer Treatment Choice, Shaping Quality of Life Outcomes
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Angela Smith, MD, MS
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| Angela Smith presents CISTO trial patient preference analysis with Sam Chang. The pragmatic study enrolled patients with recurrent high-grade NMIBC choosing bladder-sparing therapy or radical cystectomy.
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| Case-Based Panel Discussion High-Risk NMIBC Post-BCG Failure: Spare the Bladder? Bladder Sparing: Trial Overview Intravesical Gene Therapy (Combinations)
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| Yohann Loriot, MD, PhD
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| Yohann Loriot discusses bladder-sparing therapy as a rapidly expanding space in BCG-unresponsive high-risk NMIBC, driven by intravesical gene therapy, IL-15–based immunotherapy plus BCG, and oncolytic viral therapy. He highlighted durable bladder preservation with nadofaragene, high complete response rates with N-803 plus BCG, and encouraging activity for cretostimogene, while noting that cross-trial comparisons are difficult because endpoints like DFS, EFS, and RFS are not standardized.
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| Case-Based Panel Discussion High-Risk NMIBC Post-BCG Failure: Spare the Bladder? How Do Cystectomy and Bladder Sparing Compare When We Ask Patients?
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| Kathryn Hacker Gessner, MD, PhD
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| The CISTO study found that bladder-sparing therapy and radical cystectomy had similar 12-month physical function and similar cancer-specific survival in recurrent high-risk NMIBC, but the tradeoffs differed by domain. Radical cystectomy had better emotional and global quality-of-life outcomes and lower recurrence, while bladder-sparing therapy preserved bowel and sexual function and avoided surgical morbidity.
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| Real-World Outcomes of Bladder-Sparing Strategies for BCG-Unresponsive Nonmuscle-Invasive Bladder Cancer: A Multicenter Study
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| Pietro Scilipoti, MD
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| Pietro Scilipoti’s EAU 2026 multicenter study found that bladder-sparing strategies for BCG-unresponsive NMIBC can work, but outcomes vary by regimen: Gem/Doce and EMDA/MMC had lower recurrence risk than repeat BCG, and many patients who recurred or progressed ultimately proceeded to radical cystectomy. The key message was that bladder-sparing therapy is a reasonable option for selected patients who decline or cannot undergo surgery, but cystectomy remains the guideline-endorsed standard when feasible.
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| Worldwide Clinical Practices in the Management of BCG-Unresponsive Nonmuscle-Invasive Bladder Cancer
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| Mohamad Abou Chakra, MD
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| Mohamad Abou Chakra presents an analysis which showed that management of BCG-unresponsive NMIBC varies widely around the world, with intravesical chemotherapy used more often in the U.S. and parts of Asia, while radical cystectomy remained the most common choice in the Arab world and some European countries. It also highlighted a gap between approvals and real-world practice, since newer FDA-approved bladder-sparing agents were still used infrequently.
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