title: Intravesical and alternative bladder-preservation therapies in the management of non-muscle-invasive bladder cancer unresponsive to bacillus Calmette-Guérin.
abstract: Intravesical Bacillus Calmette-Guérin (BCG) remains the standard of care in the treatment of bladder carcinoma in situ and as adjuvant therapy after thorough transurethral resection of high-grade non-muscle-invasive bladder cancer. Despite BCG therapy, in up to 40% of patients it would recur and 60% to 70% of those would fail repeat BCG induction be deemed BCG unresponsive. For such patients, cystectomy remains the preferred treatment option per the American Urological Association and European Association of Urology, though some patients would be medically unfit or refuse radical surgery. Further intravesical therapy for bladder-preservation therapies may preserve quality of life in these patients and in some cases can be curative. There are numerous non-BCG intravesical salvage options available, including immunotherapy, single-agent chemotherapy, combination chemotherapy, and device-assisted chemotherapy. In addition, investigation of radiation-based treatment and other novel therapies including checkpoint inhibitors (programmed death-1/programmed death ligand-1), are currently underway. In this review, we examine the current status of alternatives to BCG in salvage therapy for bladder preservation.
authors.affiliation: Department of Urology, University of Iowa, Iowa City, IA.
authors.forename: Ryan L
authors.initials: RL
authors.lastname: Steinberg
authors.affiliation: Department of Urology, University of Iowa, Iowa City, IA.
authors.forename: Lewis J
authors.initials: LJ
authors.lastname: Thomas
authors.affiliation: Department of Urology, University of Iowa, Iowa City, IA. Electronic address: kenneth-nepple@uiowa.edu.
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Nepple
mesh_terms: D000283:Administration, Intravesical; D001500:BCG Vaccine; D004358:Drug Therapy; D006801:Humans; D007167:Immunotherapy; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D059351:Organ Sparing Treatments / Q000379:methods*; D011788:Quality of Life; D016879:Salvage Therapy / Q000379:methods*; D001749:Urinary Bladder Neoplasms / Q000628:therapy*
chemical_list: D001500:BCG Vaccine
keywords: Bacillus Calmette-Guérin; Bladder preservation; Instillation; Non–muscle-invasive bladder cancer; Urinary bladder neoplasms