Song Jiang, MD, on biomarker-driven strategies in NMIBC

Emerging biomarker strategies may play a central role in refining risk stratification and guiding treatment intensification in non–muscle-invasive bladder cancer (NMIBC), according to Song Jiang, MD, PhD. Jiang is a clinical assistant professor of urology at Northwestern Medicine in Chicago, Illinois.

Jiang emphasized that data from recent BCG/ICI combination trials consistently show that patients at higher clinical and pathologic risk derive the greatest benefit from treatment intensification strategies. Established frameworks such as AUA and NCCN risk classifications already help define these groups, incorporating features like tumor grade, stage, and recurrence risk. These systems provide a foundation for identifying patients who may require more aggressive therapy beyond standard approaches such as BCG monotherapy.

Looking ahead, Jiang highlighted the growing importance of integrating molecular and genomic tools into this risk stratification paradigm. Many contemporary trials are beginning to incorporate defined molecular subtypes to better identify which patients are most likely to benefit from intensified regimens. Approaches such as tumor microenvironment profiling—using histology combined with artificial intelligence—are gaining traction, with platforms like the Vesta bladder test aiming to refine patient selection through deeper biologic insights.

Additionally, noninvasive biomarkers such as urinary tumor DNA are emerging as particularly promising tools. These assays may help detect molecular signals that predict response to therapy, enabling clinicians to distinguish patients who are likely to respond to BCG alone from those who may require combination strategies, such as BCG plus immunotherapy. Together, these advances point toward a more personalized treatment approach, where biomarker-driven decision-making could optimize outcomes while minimizing overtreatment.