[INNOVATIONS IN THERAPIES FOR BACILLUS CALMETTE-GUERIN (BCG) FAILURE NON-MUSCLE INVASIVE PATIENTS]

Bladder cancer is categorized into invasive cancer, which pathologically infiltrates the muscle layer of the bladder, and non-muscle invasive bladder cancer that does not penetrate this layer. Non-muscle-invasive bladder cancer is further stratified into risk groups based on the likelihood of disease recurrence and progression. High-risk non-muscle-invasive tumors typically undergo conventional treatment with intravesical Bacillus Calmette-Guerin (BCG) instillations. However, it is anticipated that thirty to fifty percent of patients will experience treatment failure, leading to disease recurrence or progression, necessitating radical cystectomy as the subsequent therapeutic step. Extensive endeavors are underway to explore novel treatment modalities aiming to reduce the necessity for bladder removal. Diverse treatments, both systemic and local, administered directly into the bladder, have been investigated in recent years to mitigate the need for cystectomy. This review article provides an overview of current approved therapeutic options such as combined intravesical chemotherapy with gemcitabine and docetaxel, systemic therapy with pembrolizumab, intravesical therapy with nadofaragene firadenovec, and innovative investigational treatments including TAR-200 drug-releasing supplement therapy and novel viral therapy, cretostimogene grenadenorepvec.