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.
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.
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.
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
Correspondence to James M. McKiernan, MD, Department of Urology, Columbia University Medical Center, Herbert Irving Pavilion, Herbert Irving Pavilion, 11th Floor, 161 Fort Washington Ave, New York, NY 10032, USA. Tel: +1 212 305 5526; fax: +1 212 305 6813; e-mail: email@example.com