Reassessing CIS in BCG-Unresponsive Disease

As treatment options for BCG-unresponsive non–muscle-invasive bladder cancer continue to expand, accurate documentation of carcinoma in situ (CIS) has become increasingly important in determining therapeutic eligibility. In this video, Ravi D. Chauhan, MD, FACS, and R. Jonathan Henderson, MD, outline how direct communication with pathologists may help clarify pathology findings and potentially identify previously unrecognized CIS.

Chauhan explains that when pathology reports do not explicitly address CIS, he routinely contacts the interpreting pathologist and requests a reassessment of the specimen. He notes that including “rule out CIS” on pathology requisitions has become part of his standard workflow and describes situations in which pathology reports were subsequently amended after additional review. Chauhan also emphasizes the importance of explaining the clinical implications of CIS detection, particularly because identifying CIS may expand available treatment options for patients with prior BCG exposure.

Henderson similarly underscores the importance of proactively requesting CIS evaluation and notes that the absence of documented CIS may substantially narrow treatment pathways for patients with recurrent disease. He discusses how newer therapeutic paradigms have increased the clinical relevance of pathology details that previously may not have altered management. Both speakers describe pathology reassessment as a collaborative rather than adversarial process and compare the increasing need for actionable bladder cancer pathology markers with established reporting practices in other malignancies, such as receptor testing in breast cancer.

Editor’s Note: Ravi D. Chauhan, MD, FACS, reports relevant disclosures with Ferring Pharmaceuticals, UroGen Pharma, AstraZeneca Pharmaceuticals, and Merck. R. Jonathan Henderson, MD, reports relevant disclosures with Janssen, UroGen, AstraZeneca, and Pfizer.