BCG is the gold standard agent used in high-risk non-muscle-invasive bladder cancer (NMIBC) that is amenable to bladder sparing management. However, recent BCG shortages appear to be a chronic problem. There are limited effective intravesical options in lieu of BCG or in patients in whom BCG is not effective. This review aims to highlight emerging bladder sparing therapies and trials for NMIBC.
Patients with high-risk NMIBC who do not respond to BCG are at increased risk for progression and death from bladder cancer. There are a variety of clinical trials exploring different therapeutic approaches including checkpoint inhibition, novel chemotherapy and drug delivery, viral and gene therapy, vaccines, and targeted therapy. In the era of limited supply of BCG, there is a need for both effective first-line alternatives as and options for patients who do not respond to BCG. Fortunately, there are a variety of active trials and mechanisms exploring these areas aggressively.
Current urology reports. 2019 Nov 28*** epublish ***
Vignesh T Packiam, Ryan P Werntz, Gary D Steinberg
Department of Urology, Mayo Clinic, 200 1st St. SW, Gonda Building 7, South Rochester, MN, 55905, USA. ., Prisma Health-Upstate, Section of Urology, Department of Surgery, University of South Carolina-Greenville, 11 Park Creek Drive, Greenville, SC, 29605, USA., Department of Urology, NYU Langone Health, NYU Urology Associates, New York University, 222 E 41ST ST, 12TH Floor, New York, NY, 10017, USA.