The Management of Bacillus Calmette-Guérin (BCG) Failure in High-Risk Non-muscle Invasive Bladder Cancer: A Review Article

Abstract

Non-muscle invasive bladder cancer (NMIBC) is a common urological malignancy, and bacillus Calmette-Guérin (BCG) therapy is the gold standard treatment in intermediate and high-risk groups. However, BCG failure occurs in a significant proportion of patients, emphasizing the need for effective alternative treatment modalities to address this burden. These treatments include immunotherapy, enhanced drug delivery, targeted therapy, device-assisted chemotherapy, vaccine therapy, and gene therapy, which show varying degrees of safety and efficacy. The objective of this review is to summarize the current evidence and ongoing research on these emerging therapies, offering insight into their potential for improving patient outcomes and quality of life. Although radical cystectomy remains the standard of care for high-risk NMIBC patients unresponsive to BCG, novel treatment modalities hold promise for the future management of this challenging patient population.

The values of HER-2 expression in the non-muscle-invasive bladder cancer: a retrospective clinical study

“…BCG therapy is challenging in terms of its ineffectiveness and adverse effects. 35% patients who were tumor free at 2 years had recurrent tumors during the 2 to 11 years follow up ( 5 ). Surgical removal of the bladder should be considered in case of BCG unresponsive tumors or in NMIBC with the highest risk of progression.…”

Molecular Mechanisms of Tumor Progression and New Therapeutic Strategies for Urological Cancers

“…Bacillus Calmette-Guérin (BCG) is currently the most effective intravesical immunotherapy for high-risk NMIBC, as it can prevent disease recurrence and progression [15]. However, a relatively high rate of BCG failure, as well as the appearance of side effects, emphasize the need for effective alternative treatment strategies, such as ICIs [19]. Recent evidence has demonstrated that BCG treatment leads to changes in the tumor microenvironment, with an increase in genes regulating immune checkpoints and a significant reduction in neoantigens, which suggests the potential effectiveness of combining ICIs with BCG in relapsed NMIBC tumors [20].…”