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PEER-TO-PEER CLINICAL CONVERSATIONS
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Bladder Preservation, BCG Challenges, and Evolving Treatment Pathways in High-Risk NMIBC
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First-Line Therapy and Its Role in Bladder Preservation in High-Grade NMIBC
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Peter Black, MD, FACS, FRCSC
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| Peter Black outlines bladder-preservation strategies in high-grade non-muscle invasive bladder cancer to Ashish Kamat, covering first-line optimization through second-line options.
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Response-Guided Strategy Investigates Omission of Repeat TUR in High-Risk NMIBC
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Roberto Contieri, MD
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| Roberto Contieri presents the HuNIRe trial, a prospective observational multicenter testing a response-guided strategy to selectively omit second TURBT.
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CORE-008 CX Early Efficacy and Tolerability Data
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Aaron Berger, MD
Aaron Berger reviews early CORE-008 CX arm data evaluating cretostimogene in combination with intravesical gemcitabine in patients with BCG-exposed and BCG-unresponsive NMIBC, including CIS and high-grade papillary disease.
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| Real-World Patterns and Clinical Outcomes Among US Patients with NMIBC During the BCG Shortage
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| Suzanne Merrill, MD, FACS
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| Suzanne Merrill’s ASCO 2026 study examined real-world NMIBC treatment patterns during the BCG shortage, finding limited use of BCG induction and maintenance, particularly among patients with high-risk disease. The findings highlight gaps in guideline-concordant care and reinforce the need to optimize treatment pathways when adequate BCG delivery is not feasible.
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| Sequencing Therapies in BCG-Unresponsive, High-Risk NMIBC
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| Amanda Myers, MD, MS, and Bogdana Schmidt, MD, MPH
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| This debate on BCG-unresponsive high-risk NMIBC centered on whether gemcitabine/docetaxel should be the default first-line bladder-preserving therapy. One side argued it offers durable control, good tolerability, low cost, and wide access, while the other pushed for individualized sequencing based on disease features, patient priorities, and the growing menu of approved bladder-sparing options.
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| Quality Care Measures Among Patients with High-Risk NonMuscle-Invasive Bladder Cancer with Papillary Carcinoma or CIS Receiving Front-Line BCG or Other Intravesical Therapies
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| Mukul Singhal, PhD
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| Mukul Singhal’s AUA 2026 presentation found gaps in frontline quality care for Medicare patients with high-risk NMIBC receiving BCG or other intravesical therapy, including delays in treatment, incomplete BCG delivery, and poor adherence to recommended surveillance cystoscopy and repeat TURBT. The study demonstrates substantial room to improve real-world care processes for both BCG and non-BCG bladder-sparing treatment pathways.
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| BCG-Exposed Nonmuscle-Invasive Bladder Cancer: Survival Benchmarks, Bladder-Sparing Strategies, and Implications for Trial Design - Beyond the Abstract
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| Renzo Di Natale, MD, MSc, and Roger Li, MD
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| This study found that BCG-exposed and BCG-unresponsive NMIBC had similarly poor outcomes, with no meaningful differences in recurrence, progression, metastasis, or overall survival. It also showed that bladder-sparing therapy remains common after BCG failure, but the findings argue for biologically driven trial design and better biomarkers, such as urinary tumor DNA, rather than relying only on timing-based disease labels.
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| Optimizing Oncological Outcomes in High-Grade NonmuscleInvasive Bladder Cancer: The Impact of a Surgeon-Led Treatment Pathway - Beyond the Abstract
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| Pietro Scilipoti, Giuseppe Rosiello, Alfonso Santangelo et al.
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| This study showed that a surgeon-led pathway for high-grade NMIBC was associated with better staging quality and stronger long-term outcomes, including higher complete response at re-TURBT and improved 5-year disease-free survival. The study suggests that early centralized, guideline-based care can improve bladder preservation and cancer control, although tumor biology still strongly influences relapse risk.
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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’s SUO 2025 study showed that worldwide management of BCG-unresponsive NMIBC is highly variable, with intravesical chemotherapy favored in the US and parts of Asia and radical cystectomy more commonly chosen in Arab countries and some European regions. Notably, recent FDA-approved bladder-sparing therapies for BCG-unresponsive disease have limited real-world use, highlighting variation between regulatory availability and clinical practice patterns.
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