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
...Treatment for Bladder Cancer
...rameters (grade, stage, presence of carcinoma i...
For maintenance, use the 6+3 schedule (als...
...full doses of BCG for induction, and dose r...
...nts with increasing disease (number, size, grade...
...who have recurrent disease after adequate...
...nued BCG is not useful in patients wi...
...teriuria does not appear to increase toxicitie...
...G appears to be safe and effective in select pati...
...inolones should not be administered...
...is no evidence that combination BCG plu...
Consensus Recommendations
...sus Recommendatio...
...of lidocaine or excessive lubricants is not...
...sary to rotate patients every 15 min post BC...
...ts should be provided with a template to record BC...
See Figure 1 note for def
...ee Figure 1 note for definitions of Low, Int...
High Risk Patients
High Risk Patien...
...r high risk patients should be conside...
...risk (high grade) patients should...
...sidual or recurrent CIS at the 3 month cystosc...
...vesical chemotherapy is a reasonable option fo...
Intermediate Risk Patients
...ediate Risk Patient...
...n and at least 1 year of maintenance therapy sh...
Low Risk Patients
...ow Risk Patien...
...w risk patients should not receive BCG...
Figure 1. Treatment Algorithm for Non-Muscle Invasive Bladder Cancer
...Treatment Algorithm for Non-Muscle Invasive...