Topic: Non-Muscle Invasive Bladder Cancer

Bladder Cancer Journal Vol. 6, Issue 4

Upregulated FGFR3 signaling in NMIBC and MIBC, the diagnosis and management of checkpoint inhibitor side effects in bladder cancer patients, the etiology of treatment delays in patients receiving neoadjuvant chemotherapy for MIBC, and 25-year trends in stage-specific incidence rates for bladder cancer.

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Adaptive Immune Resistance to Intravesical BCG in NMIBC: Implications for Ongoing and Future BCG Unresponsive Clinical Trials

Trinity J. Bivalacqua, MD, PhD, Director of Urologic Oncology at Johns Hopkins Medicine, discusses potential solutions to the issues with bacillus Calmette-Guérin (BCG) as a treatment for high-risk non-muscle invasive bladder cancer (NMIBC). Intravesical BCG is more effective than chemotherapy for NMIBC, but approximately ⅓ of high-risk patients are BCG-unresponsive, and there is also a BCG shortage. Dr. Bivalacqua lists potential solutions to both these problems, including early cystectomy, increasing the availability of BCG by using alternative strains, and enhancing immunotherapy. He concludes by discussing research intended to characterize immune cell expression among patients with NMIBC treated with BCG which found that immune checkpoint inhibition with BCG may be beneficial in a subset of patients who experience tumor recurrence after BCG.

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BCG Failure: Defining Failure and Managing Difficult Cases of Non-Muscle Invasive Bladder Cancer

Donald L. Lamm, MD, FACS, Director of BCG Oncology and Clinical Professor of Surgery at the University of Arizona College of Medicine, discusses the criteria required of studies looking for alternative drug therapies to Bacillus Calmette-Guerin (BCG) to treat non-muscle invasive bladder cancer (NMIBC). Because there are many BCG refractory, recurrent, intolerant, and unresponsive patients, and because there is a global shortage of BCG, new drugs are much needed. To get funding, studies will require FDA approval, and Dr. Lamm suggests that researchers are more likely to receive approval quickly by using standard definitions and providing clear follow-up and end-points in their proposals.

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FDA Approves Pembrolizumab for New Indication of NMIBC

Daniel P. Petrylak, MD, discusses the recent FDA approval of the checkpoint inhibitor pembrolizumab for treating cystectomy-ineligible (or those who have refused cystectomy) non-muscle invasive bladder cancer patients who have also failed BCG. He details the prior lack of available treatment for this disease, explains the function of the drug as a checkpoint inhibitor, and describes the study that led to the drug’s approval.

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BCG Maintenance Should Be Less Intense

Michael S. Cookson, MD, MMHC, suggests that the primary evidence does not provide convincing evidence in favor of 3 years of bacillus Calmette-Guérin (BCG) maintenance for non-muscle-invasive bladder cancer (NMIBC). He also notes that long-term BCG often leads to toxicities, contributing to low patient compliance.

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