Taylor Goodstein, MD, highlights contemporary experience with gene therapies for NMIBC

Data presented at the 2025 Society of Urology Oncology Annual Meeting in Phoenix, Arizona, shed light on contemporary use of approved and investigational gene therapies for patients with non–muscle invasive bladder cancer (NMIBC).¹

In an interview with Urology Times®, presenting author Taylor Goodstein, MD, outlined some of the key findings from the study, noting that this analysis has laid the groundwork for a study looking at spatial transcriptomics of the tumor microenvironment for novel gene therapies. Goodstein is second-year SUO fellow at Emory University in Atlanta, Georgia.

In total, the study included 51 patients who received gene therapy for BCG-unresponsive NMIBC at Emory University between January 2017 and June 2025. The majority of patients (72%) received nadofaragene firadenovec-vncg (Adstiladrin) as their first line of gene therapy, with the next most common first line options being detalimogene voraplasmid (15%) and cretostimogene grenadenorepvec (13%).

Overall, 68% of patients experienced a high-grade recurrence after initial gene therapy. The median time to recurrence was 4 months (range, 2 to 63 months). Among patients whose disease recurred, 60% went on to receive treatment with a subsequent agent. Of these, 24% were retreated with the same agent and 38% were treated with gemcitabine/docetaxel. Four patients had received multiple gene therapies.

When asked about the decision-making process after recurrence on a gene therapy, Goodstein noted, “A lot of [it] is shared decision-making between the patient and the provider. You have a very frank conversation with these patients that [they’re] in a data-free zone, especially after they've recurred after their first gene therapy.”

Goodstein also acknowledged that many patients may be hesitant to undergo retreatment with a second gene therapy after a recurrence given the lack of data on some of these agents.

The authors also reported, “At the time of data [collection], 11 patients (21%) had proceeded to cystectomy, 7 (13%) had developed metastatic disease, and 9 (17%) had died (4 from bladder cancer, 8%).”

REFERENCE

1. Goodstein T, Ogan K, Master V, et al. Contemporary experience using gene therapies for NMIBC at an academic center: Outcomes and sequencing. Presented at: Society of Urologic Oncology Annual Meeting; December 2-5, 2025; Phoenix, Arizona. Poster 148