title: New agents for bacillus Calmette-Guérin-refractory nonmuscle invasive bladder cancer.
abstract: OBJECTIVE
  Radical cystectomy is the standard of care for patients who fail intravesical bacillus Calmette-Guérin (BCG) for nonmuscle invasive bladder cancer (NMIBC). For patients unwilling or unable to undergo cystectomy, numerous local therapies exist, although few are approved by the Food and Drug Administration. This review describes available therapies for this challenging clinical entity.
  
  
  RESULTS
  Combination intravesical chemotherapy, targeted therapy, and drug delivery enhancement have all been under recent investigation and are promising, although none has proven superior as of yet.
  
  
  CONCLUSIONS
  While BCG is standard treatment for intermediate and high-risk NMIBC, many patients fail therapy with recurrence or progression. Early cystectomy is the standard of care for BCG failure; however, many patients are unwilling or unable to undergo cystectomy. Multiple intravesical therapies have been used in this BCG failure population with moderate success, and, recently, technologies to improve drug delivery or create novel drugs have also been applied. Comparing efficacy of these therapies remain challenging as study cohorts are heterogeneous and study designs are variable. However, there are an increasing number of novel treatment options that can be offered to patients faced with recurrent NMIBC after BCG who seek bladder-sparing therapy.
authors.affiliation: aDepartment of Urology, New York Presbyterian Hospital, Columbia University bDepartment of Urologic Oncology, Columbia University Medical Center cDepartment of Urology, Columbia University Medical Center, New York, USA.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Ahn
authors.forename: Rashed A
authors.initials: RA
authors.lastname: Ghandour
authors.forename: James M
authors.initials: JM
authors.lastname: McKiernan
mesh_terms: D000283:Administration, Intravesical; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000628:therapy*; D015653:Cystectomy; D004358:Drug Therapy; D006801:Humans; D007167:Immunotherapy / Q000379:methods*; D009163:Mycobacterium bovis / Q000276:immunology; D015996:Survival Rate; D017211:Treatment Failure; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000628:therapy*