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Opinion|Videos|December 19, 2024
Treatment Strategies for Patients with NMIBC: Importance of Risk Stratification
Author(s)Mark D. Tyson, II, M.D., M.P.H.
A panelist discusses how Non-muscle Invasive Bladder Cancer (NMIBC) treatment varies by risk stratification (low, intermediate, and high-risk), with BCG immunotherapy being standard for high-risk patients, while newer options like pembrolizumab and gene therapies are emerging for BCG-unresponsive cases, and treatment decisions between intravesical versus systemic therapy depend on risk level and previous treatment response.
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- Please share where the field of Non-muscle Invasive Bladder Cancer (NMIBC) is right now. Consider the following topics, which will be discussed in depth later on:
- Patient risk stratification
- Approved agents
- Investigational agents
- Please provide a brief overview of risk stratification for patients with NMIBC and treatment strategy for each group.
- What are the FDA-approved agents for treating patients with NMIBC, and what treatment options are available for BCG-naïve and BCG-unresponsive patients?
- How do intravesical therapies compare to intravenous therapies in this context?
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Peter Clark, MD, discusses key updates to NMIBC guidelines, including revisions to risk stratification, the emerging role of biomarkers, and how to navigate treatment options for BCG-unresponsive disease.
John P. Sfakianos, MD, discusses how ctDNA can be optimally integrated into bladder cancer clinical trials.
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One year following the approval of the gemcitabine intravesical system, Joseph Jacob, MD, reflects on the expanding treatment landscape in BCG-unresponsive NMIBC.
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Sandip Prasad, MD, discusses patient selection for chemoablation in recurrent LG-IR-NMIBC and considerations when counseling patients about a nonsurgical approach.
Enfortumab vedotin-ejfv (Padcev) plus pembrolizumab (Keytruda) showed the strongest EFS, OS, and pCR associations among neoadjuvant MIBC strategies in a network meta-analysis, although perioperative design limits attribution.
Sandip Prasad, MD, MPhil, discusses the evolving role of chemoablation in recurrent low-grade, intermediate-risk NMIBC, including patient selection and treatment considerations.
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