Open AccessEmerging treatments for bacillus Calmette–Guérin-unresponsive non-muscle-invasive bladder cancer
Author(s) -
Hyung Suk Kim,
Ho Kyung Seo
Publication year - 2021
Publication title -
investigative and clinical urology
Language(s) - Uncategorized
Resource type - Journals
SCImago Journal Rank - 0.653
H-Index - 14
eISSN - 2466-054X
pISSN - 2466-0493
DOI - 10.4111/icu.20200602
Subject(s) - medicine , cystectomy , bladder cancer , immunotherapy , adjuvant , refractory (planetary science) , disease , gold standard (test) , clinical trial , urology , bcg vaccine , oncology , cancer , surgery , immunology , vaccination , physics , astrobiology
Intravesical bacillus Calmette-Guérin (BCG) immunotherapy has been the gold standard adjuvant treatment for intermediate- and high-risk non-muscle-invasive bladder cancer (NMIBC) after transurethral resection of bladder tumor (TURBT). BCG immunotherapy prevents disease recurrence and progression to muscle-invasive disease following TURBT. Although most patients initially respond well to intravesical BCG, considerable concern has been raised for patients with BCG failure who are refractory or recur in 6 months after their last BCG, which implies 'BCG-unresponsiveness'. Based on current clinical guidelines, early radical cystectomy (RC) is recommended to treat BCG-unresponsive NMIBC. However, due to the high risk of morbidity and mortality of RC and patients' desire to preserve their own bladder, there is a critical unmet need for alternative conservative treatments as bladder-sparing strategies in BCG-unresponsive patients. Trials for effective bladder-sparing treatments are ongoing, and several novel agents have been recently tested in the NMIBC setting. The goal of this review is to introduce and summarize recently reported novel and emerging drugs and ongoing clinical trials for BCG-unresponsive NMIBC.