John Sfakianos, MD, discusses evolving management of recurrent LG-IR-NMIBC

In this video, John P. Sfakianos, MD, discusses the challenges of managing recurrent low-grade, intermediate-risk non-muscle invasive bladder cancer (LG-IR-NMIBC) and the role of chemoablation in the treatment landscape. Sfakianos is a professor of urology at the Icahn School of Medicine at Mount Sinai.

Sfakianos describes recurrent disease as the central challenge in this patient population, noting that repeated transurethral resections of bladder tumor (TURBTs) can become burdensome, particularly for older patients and those with significant comorbidities. Although intravesical adjuvant therapies have been used to reduce recurrence, patients may continue to experience tumors that require repeated procedures. As a result, some clinicians have turned to surveillance for select patients, particularly those who may not be ideal candidates for frequent trips to the operating room. Chemoablation has recently emerged as another option in this setting.

Sfakianos says he does not view specific clinical or tumor characteristics as necessary for determining eligibility for chemoablation among patients with recurrent LG-IR-NMIBC. Instead, he considers chemoablation a potential first-line approach across this population, including patients with a high volume of disease for whom TURBT may be technically challenging. Reducing tumor burden before or instead of resection, he explains, could make subsequent management less invasive while potentially allowing some patients to avoid surgery altogether.

Sfakianos also discusses his use of mitomycin for intravesical solution (Zusduri) as a first-line treatment option, highlighting its potential to change the decision-making process after treatment. Patients who achieve a complete response may avoid further intervention, while those with a partial response may have a reduced tumor burden that can be managed with office fulguration rather than another TURBT. For older or medically complex patients, he notes, substantial tumor reduction could also make active surveillance a more reasonable option. In this way, chemoablation may provide clinicians with greater flexibility in tailoring subsequent management to each patient's response.