Alternative therapies in patients with non-muscle invasive bladder cancer

Abstract

Bladder cancer (BC) is one of the leading causes of cancer-related deaths worldwide. Despite, the majority of the cases were diagnosed as non-muscle invasive bladder cancer (NMIBC) with favorable prognosis, it has tendency to recur or progress to a higher grade or stage. The first line treatment of patients with NMIBC is transurethral resection with adjuvant therapies primarily intravesical Bacillus Calmette-Guérin (BCG) immunotherapy. However, in a portion of patients whose BCG treatment failed, alternative treatments may be required. Furthermore, intravesical BCG may be contraindicated in or untolerated by a group of patients. For these patients, some treatment options are readily available and a variety of them are currently under clinical investigation. In this review, these alternative therapies have been summarized.

<p>Humanistic and Economic Burden of Non-Muscle Invasive Bladder Cancer: Results of Two Systematic Literature Reviews</p>

“…There are a number of emerging therapies for NMIBC. 121 , 122 Chemothermotherapy is one such treatment option for patients with NMIBC who fail intravesical BCG and develop disease recurrence. 121 , 123 , 124 It involves the intravesical application of heated chemotherapy to the bladder through use of microwaves to heat the local bladder environment or through circulation of heated fluids (hyperthermic intravesical chemotherapy [HIVEC]).…”

“… 121 , 123 , 124 It involves the intravesical application of heated chemotherapy to the bladder through use of microwaves to heat the local bladder environment or through circulation of heated fluids (hyperthermic intravesical chemotherapy [HIVEC]). 121 , 122 , 125 , 126 In a meta-analysis of 12 studies, intravesical chemothermotherapy was associated with a significantly decreased risk of disease recurrence compared with normal-temperature chemotherapy after 2 years, with no difference in the rate of AEs. 125 However, AEs of hematuria, bladder spasms, and pain have been reported with chemothermotherapy.…”

“… 125 However, AEs of hematuria, bladder spasms, and pain have been reported with chemothermotherapy. 122 , 127 While no studies on chemothermotherapy were identified in our SLR, it is a treatment option that should be considered by the treating physician. Radical cystectomy is a recommended treatment following BCG failure in NMIBC, so that intravesical chemothermotherapy is an alternative bladder-sparing option to normal intravesical chemotherapy in BCG-refractory patients that may delay or avoid the need for this highly-morbid surgical procedure.…”

“…Radical cystectomy is a recommended treatment following BCG failure in NMIBC, so that intravesical chemothermotherapy is an alternative bladder-sparing option to normal intravesical chemotherapy in BCG-refractory patients that may delay or avoid the need for this highly-morbid surgical procedure. 122 , 123 In addition, reducing the dose of BCG to a third (1/3) is an alternative approach to alleviate the side effects of treatment. However, a study found no difference in the rate and occurrence of local or systemic side effects between patients receiving a reduced (1/3) or full BCG dose after 1 and 3 years of maintenance therapy.…”

Combination of Intravesical Bacille Calmette-Guérin and Chemotherapy vs. Bacille Calmette-Guérin Alone in Non-muscle Invasive Bladder Cancer: A Meta-Analysis

“…The mainstay for treating NMIBC is transurethral resection of bladder tumor (TURBT) followed by adjuvant intravesical therapies, primarily including bacille Calmette-Guérin (BCG) immunotherapy (6). Although BCG has been proved to be effective in preventing tumor recurrence and progression, not all NMIBC patients could receive it due to considerable side effects, which severely compromise its therapeutic effects (2, 8, 9). Since a large proportion of NMIBC patients poorly tolerate BCG, there is a pressing need for alternative treatments.…”