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
...ent for Bladder Cancer...
...l parameters (grade, stage, presence of...
For maintenance, use the 6+3 schedule (a...
...f BCG for induction, and dose reductio...
...ents with increasing disease (number, size,...
...atients who have recurrent disease after adequat...
...BCG is not useful in patients with BCG unr...
...tomatic bacteriuria does not appear to...
...be safe and effective in select patients who are...
...should not be administered prior to,...
...re is no evidence that combination BCG...
Consensus Recommendations
...onsensus Recommen...
...caine or excessive lubricants is not recomm...
...cessary to rotate patients every 15...
...ould be provided with a template t...
See Figure 1 note for def
...1 note for definitions of Low, Intermediate...
High Risk Patients
...igh Risk Patients...
...rapy for high risk patients should be con...
...sk (high grade) patients should recei...
...atients with residual or recurrent C...
...ntravesical chemotherapy is a reasonable o...
Intermediate Risk Patients
...ediate Risk Patients...
...tion and at least 1 year of maintenance therapy...
Low Risk Patients
...isk Patients...
...atients should not receive BCG (Figure 1).678...
Figure 1. Treatment Algorithm for Non-Muscle Invasive Bladder Cancer
...gure 1. Treatment Algorithm for Non-Muscl...