Intravesical therapy for urothelial carcinoma of the urinary bladder: a critical review

Abstract

The management of non-muscle-invasive urothelial carcinoma of the bladder (UCB) is a challenge for physicians and patients alike. This is largely due to the heterogeneous natural history of this disease, in which tumors range from indolent to rapidly progressive and eventually fatal. Moreover, the high rate of recurrence and progression cause significant morbidity, expense, and detriment to quality of life. The advent of effective and safe intravesical therapies has improved the management of non-muscle-invasive UCB. Nevertheless, despite over 30 years of research and clinical experience, the mechanism, risks, benefits, and optimal regimens and treatment algorithms remain unclear. Although immunotherapy with bacillus Calmette-Guerin (BCG) has been the mainstay of intravesical treatment and represents a significant advance in the interaction of immunology and oncology, its clinical effectiveness is accompanied by a wide range of adverse events. Here, we review the literature on intravesical immunotherapy and chemotherapy with the aim of evaluating the clinical utility of the different treatments and providing recommendations. Many studies over the years have compared efficacy and toxicities of different agents and regimens, and certain conclusions are now well supported by high-level evidence. Future perspectives and promising advances in drug development are discussed and areas of improvement are identified in order to promote better cancer control and decrease the rate and severity of side-effects.

The quality of life in patients during intravesical treatment and correlation with local symptoms

“…2 About 70% patients had non-muscle invasive cancer(superficial cancer) and 30% had muscle invasive cancer. 3 Several well-designed clinical trials had demonstrated transurethral resection plus intravesical treatment could reduce recurrence rate significantly. 4,5 Intravesical adjuvant treatment with antineoplastic agents after transurethral resection was a standard therapy for patients with intermediate or high-risk non-muscle-invasive bladder cancer.…”

The dilemma of cystectomy in old-old and oldest-old patients

“…Intravesical bacillus Calmette-Gúerin (BCG) is widely accepted as the most effective therapy for patients with high-risk nonmuscleinvasive BC [34]. Intravesical BCG can delay recurrence and progression, decreasing the need for immediate cystectomy [34][35][36]. Several studies have demonstrated a lower response rate to intravesical BCG in the elderly compared with their younger counterparts [2].…”

“…Looking at the literature regarding complications of RC and elderly individuals, the situation is contradictory. A substantial number of authors report that, in their experience, RC in octogenarians is not burdened with higher complications and mortality rates [10,35,45,56,[60][61][62], and can be safely performed. However, there are also important authors who inform on a significant increased risk for morbidity and mortality in old-old and oldest-old patients [64,63,64].…”

A novel, safe, fast and efficient treatment for Her2‐positive and negative bladder cancer utilizing an EGF‐anthrax toxin chimera

“…Despite efforts to address these issues with adjuvant therapies involving the intravesical instillation of chemotherapeutic and immunomodulatory agents, high rates of disease recurrence and progression continue to persist. These strategies (e.g., using mitomycin C or Bacillus Calmette–Guerin [BCG]) require at least 2 hr‐long treatment per session and have been linked to local and systemic side effects including urinary symptoms, cystitis, fever and inflammatory response . This situation is worsened by the current BCG shortage .…”