Current Clinical Trials in Non-muscle-Invasive Bladder Cancer: Heightened Need in an Era of Chronic BCG Shortage

• Published in: Current urology reports Vol. 20; no. 12; p. 84
• Main Authors: Packiam, Vignesh T., Werntz, Ryan P., Steinberg, Gary D.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.12.2019
• Subjects: Administration, Intravesical; Antibodies, Monoclonal - therapeutic use; Antineoplastic Agents - therapeutic use; Antineoplastic Agents, Immunological - therapeutic use; BCG Vaccine - administration & dosage; BCG Vaccine - supply & distribution; Cancer Vaccines - therapeutic use; Cell Cycle Checkpoints - drug effects; Clinical Trials as Topic; Disease Progression; Genetic Therapy; Humans; Immunotherapy - methods; Medicine; Medicine & Public Health; Nephrology; Oncolytic Virotherapy; Section Editor; Topical Collection on Urothelial Cancer; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - therapy; Urology; Urothelial Cancer (S Daneshmand; Clinical trials; Chemotherapy; Urothelial carcinoma; Immunotherapy; Non-muscle-invasive bladder cancer; BCG-unresponsive
• ISSN: 1527-2737; 1534-6285
• DOI: 10.1007/s11934-019-0952-y

Purpose of Review BCG is the gold standard agent used in high-risk non-muscle-invasive bladder cancer (NMIBC) that is amenable to bladder sparing management. However, recent BCG shortages appear to be a chronic problem. There are limited effective intravesical options in lieu of BCG or in patients in whom BCG is not effective. This review aims to highlight emerging bladder sparing therapies and trials for NMIBC. Recent Findings Patients with high-risk NMIBC who do not respond to BCG are at increased risk for progression and death from bladder cancer. There are a variety of clinical trials exploring different therapeutic approaches including checkpoint inhibition, novel chemotherapy and drug delivery, viral and gene therapy, vaccines, and targeted therapy. Summary In the era of limited supply of BCG, there is a need for both effective first-line alternatives as and options for patients who do not respond to BCG. Fortunately, there are a variety of active trials and mechanisms exploring these areas aggressively.