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Updates on the use of intravesical therapies for non-muscle invasive bladder cancer: how, when and what

  • Charles C. Peyton
  • Juan Chipollini
  • Mounsif Azizi
  • Ashish M. Kamat
  • Scott M. Gilbert
  • Phillippe E. Spiess
Topic Paper
  • 20 Downloads

Abstract

Introduction

Intravesical therapy has been an important aspect of the management of non-muscle invasive bladder cancer (NMIBC) for 40 years. Bacillus Calmette–Guerin (BCG) is considered standard of care for intermediate and high-grade non-invasive disease, yet understanding the nuances of subsequent intravesical therapy is important for any provider managing bladder cancer. Herein, we review the literature and describe optimal use of intravesical therapies for NMIBC.

Methods

A comprehensive search of the medical literature was performed and highlighted in this review of intravesical therapy for NMIBC.

Results

Post-resection intravesical Mitomycin C therapy for low-risk disease remains an important component of care, and gemcitabine now has level-one evidence demonstrating efficacy in this setting but is not yet a guideline recommendation. BCG intravesical therapy remains the most effective therapy preventing recurrence and progression of intermediate and high-risk NMIBC. Adequately characterizing BCG-failure is critical in determining the next step in management which includes radical cystectomy, additional intravesical immunotherapy, chemotherapy with intravesical gemcitabine ± docetaxel and clinical trials.

Conclusions

Intravesical therapy remains the mainstay of treatment for NMIBC and bladder preservation. Intravesical induction BCG followed by maintenance therapy remains standard of care for intermediate and high-risk patients. Detailing the timing and characteristics of recurrence after intravesical therapy is crucial in determining subsequent treatment recommendations. Current clinical trials focus on systemic immunotherapy and enhancing the intravesical immune response by augmenting the delivery mechanism.

Keywords

Non-muscle invasive bladder cancer Intravesical therapy BCG failure 

Notes

Author contributions

CP: protocol/project development, data collection/management, analysis, manuscript writing, supervision. JC: data collection/management, analysis, manuscript writing, critical revisions. MA: analysis, manuscript editing. AK: critical revisions, supervision. SG: protocol/project development, data collection/management, analysis, manuscript editing, critical revisions, supervision. PS: protocol/project development, project management, critical revisions, supervision.

Funding

No funding was required for this work.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest or relevant disclosures to this work.

Informed consent

No patient data was included in this report and informed consent was not required.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Charles C. Peyton
    • 1
  • Juan Chipollini
    • 1
  • Mounsif Azizi
    • 1
  • Ashish M. Kamat
    • 2
  • Scott M. Gilbert
    • 1
  • Phillippe E. Spiess
    • 1
  1. 1.H. Lee Moffitt Cancer Center and Research InstituteTampaUSA
  2. 2.The University of Texas MD Anderson Cancer CenterHoustonUSA

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