Immunotherapy for Bladder Cancer
Key Points
Key Points
General
- Non-muscle invasive bladder cancer (NMIBC – sometimes referred to as “superficial” bladder cancer) is the most common presentation of urothelial cancer.
Bacillus Calmette-Guérin (BCG)
- BCG activates the immune system to recognize and destroy malignant cells.
Immuno-Oncology
- Novel treatment strategies — such as those involving immune checkpoint blockade, cytokines, monoclonocal antibodies, T-cell therapies, oncolytic viruses and vaccines — rely on agents with immunomodulatory mechanisms. These treatments have allowed a subset of patients to benefit from durable response rates, often with a more tolerable adverse event profile than traditional therapies.
- Atezolizumab, durvalumab, avelumab, pembrolizumab and nivolumab are FDA-approved and recommended in locally advanced or metastatic urothelial carcinoma that has previously been treated with platinum-based chemotherapy, or has relapsed within 12 months of perioperative platinum-based chemotherapy.
- Pembrolizumab demonstrated significant improvement in overall survival over chemotherapy. It is the first and only therapy to show level A evidence at this time.
- There is no reason to select one agent over the others, aside from practical considerations of dosing and convenience.
BCG Treatment for Bladder Cancer
...BCG Treatment...
Clinical parameters (grade, stage, presence...
For maintenance, use the 6+3 schedule (also known...
...of BCG for induction, and dose reduction during...
...h increasing disease (number, size,...
...ve recurrent disease after adequate BCG treatme...
...tinued BCG is not useful in patient...
...bacteriuria does not appear to increase toxi...
...s to be safe and effective in select patients...
...es should not be administered prior to, or...
...is no evidence that combination BCG p...
Consensus Recommendations
...Consensus R...
...lidocaine or excessive lubricants is no...
...cessary to rotate patients every 1...
...should be provided with a template to...
See Figure 1 note for def
...1 note for definitions of Low, Intermediate and...
High Risk Patients
...High R...
...r high risk patients should be considered stand...
...gh grade) patients should receive mainte...
...ents with residual or recurrent CIS at the 3 month...
Intravesical chemotherapy is a reasonab...
Intermediate Risk Patients
...Intermediate Risk Pa...
...induction and at least 1 year of m...
Low Risk Patients
...Low...
...tients should not receive BCG (Figure 1).678...
Figure 1. Treatment Algorithm for Non-Muscle Invasive Bladder Cancer
...ure 1. Treatment Algorithm for Non-Muscle Invasi...