Non–Muscle Invasive-Bladder Cancer Overview

Video content above is prompted by the following:

Practice Updates and Treatment Approaches in Non-Muscle Invasive Bladder Cancer

Panel Introduction

Moderator:

• Dr Ashish Kamat - University of Texas MD Anderson Cancer Center, Houston, Texas

Expert Panelists:

• Dr Bogdana Schmidt - University of Utah, Salt Lake City, Utah
• Dr Sam Chang - Vanderbilt University, Nashville, Tennessee
• Dr Katie Murray – NYU Langone Health, New York, New York

Staging, Grading, and Treatment of Non–Muscle-Invasive Bladder Cancer

Key Themes

• Risk Stratification Systems: The panel discussed various risk classification systems for non–muscle-invasive bladder cancer (NMIBC), comparing AUA, EU, and international bladder cancer group approaches to categorizing patients as low, intermediate, or high risk.

• Treatment Algorithms: Dr Kamat presented the complex treatment flowchart adapted from NCCN guidelines showing different treatment pathways based on risk classification, BCG exposure status, and response to therapy.
• BCG Therapy Considerations: The panel emphasized BCG as standard first-line therapy for high-risk NMIBC patients, noting the continued relevance of the 6-week induction plus 3-week maintenance protocol despite global BCG shortages.
• Treatment Challenges: Discussion highlighted that despite appropriate BCG therapy, approximately 30% to 40% of patients still experience recurrence, creating a need for alternative treatment options.

Notable Insights

• Dr Kamat emphasized that the “6 plus 3” BCG protocol remains the standard of care globally when supplies are available, with recurrence rates lower in contemporary data but progression still occurring in some patients.
• The panel presented the consensus definition of “BCG unresponsive disease” developed collaboratively by the AUA, FDA, and IBCG to standardize criteria for when patients should discontinue BCG therapy.