Medical treatment

New perspectives in the medical treatment of non-muscle invasive bladder cancer: immune checkpoint inhibitors and beyond

This article was originally published here

Cells. 2022 Jan 21;11(3):357. doi: 10.3390/cells11030357.

ABSTRACT

Non-muscle invasive bladder cancer (NMIBC) is characterized by a high cure rate, but also by a non-negligible probability of recurrence and risk of progression to a muscle-invasive disease. Management of NMIBC requires appropriate local resection and staging, followed by risk-based treatment with intravesical agents. For many years, the current gold standard treatment for patients with intermediate- or high-risk disease has been transurethral resection of the bladder (TURB) followed by intravesical instillation of Bacille Calmette-Guérin (BCG). Unfortunately, in about half of high-risk patients, intravesical BCG treatment fails and NMIBC persists or recurs early. While radical cystectomy remains the gold standard for these patients, new therapeutic targets are being identified and studied. Radical cystectomy can actually provide excellent long-term disease control, but can profoundly interfere with quality of life. In particular, the increased expression of immune checkpoints in BCG unresponsive patients and the activity of immune checkpoint inhibitors (ICIs) in advanced bladder cancer have justified testing for ICIs in NMIBC. . Recently, pembrolizumab showed promising activity in BCG-unresponsive NMIBC patients, gaining FDA approval. Meanwhile, several new drugs with alternative mechanisms of action have been shown to be safe and effective in treating NMIBC and more are being studied. The objective of this review is to analyze and describe the clinical activity of new emerging drugs in BCG-unresponsive NMIBCs with a focus on immunotherapy outcomes.

PMID:35159167 | DOI: 10.3390/cells11030357