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...
...al parameters (grade, stage, presence of carcin...
...ce, use the 6+3 schedule (also known as the 'La...
...doses of BCG for induction, and dose reduct...
...ents with increasing disease (number, size, grade...
...o have recurrent disease after adequate BCG...
...ed BCG is not useful in patients with B...
...bacteriuria does not appear to increas...
...appears to be safe and effective in select pa...
...inolones should not be administered prior to, or w...
...re is no evidence that combination B...
Consensus Recommendations
...Consensus Reco...
The use of lidocaine or excessive lubricant...
...is not necessary to rotate patien...
...should be provided with a template...
See Figure 1 note for def
...igure 1 note for definitions of Low, Intermediat...
High Risk Patients
...High Risk Pa...
...erapy for high risk patients should be...
...grade) patients should receive maintenance...
...tients with residual or recurrent CIS at the...
...avesical chemotherapy is a reasonable option...
Intermediate Risk Patients
...induction and at least 1 year of...
Low Risk Patients
...Low Risk Patients...
...patients should not receive BCG (Figure...
Figure 1. Treatment Algorithm for Non-Muscle Invasive Bladder Cancer
Figure 1. Treatment Algorithm for Non-Muscle Inv...