Treating Patients With High-Risk BCG-Unresponsive NMIBC


An expert urologist reviews the clinical hallmarks of high-risk BCG-unresponsive NMIBC and discusses the unmet needs and treatment goals.

This is a video synopsis/summary of an Investigator Perspectives featuring Neal Shore, MD, FACS.

Patients with high-risk non–muscle-invasive bladder cancer (NMIBC) who are bacillus Calmette-Guérin (BCG) unresponsive, especially those with persistent T1 lamina propria invasion or carcinoma in situ, are at high risk of progression to MIBC. Assuming no BCG shortage, standard options include radical cystectomy or clinical trial enrollment. For patients unwilling or medically unable to undergo cystectomy, intravesical chemotherapy with mitomycin C, gemcitabine, or gemcitabine plus docetaxel may be offered.

The key priority is preventing progression from high-risk NMIBC, which occurs in 15% to 30% within 1 to 2 years. Once muscle invasion develops, there is risk for metastases. Despite advances, median survival with metastatic disease remains poor. Avoiding progression is paramount.

Recurrence is also a major challenge with all risk levels of NMIBC. Repeat procedures for detection and treatment make this the most resource-intensive solid tumor, with impacts on quality of life and time off work. The goals are cure, preventing progression, and reducing recurrence rates.

Video synopsis is AI-generated and reviewed by Urology Times® editorial staff.

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