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Systemic immunotherapy for BCG unresponsive nonmuscle-invasive bladder cancer
Karima Oualla1, Mehdi Alem1, Jeremy Teoh2
1Medical Oncology Department, Hassan II University Hospital, Sidi Mohamed Ben Abdellah University, Fes, Morocco.
Current Opinion in Urology
|September 15, 2025
Summary
Systemic immunotherapy offers new bladder-sparing options for Bacillus Calmette-Guérin (BCG)-refractory nonmuscle-invasive bladder cancer (NMIBC). Advances like immune checkpoint inhibitors are transforming treatment for patients with this challenging condition.
Area of Science:
- Urology
- Oncology
- Immunotherapy
Background:
- Nonmuscle-invasive bladder cancer (NMIBC) refractory to Bacillus Calmette-Guérin (BCG) treatment presents a significant clinical challenge.
- Limited bladder-sparing therapeutic strategies exist for patients with BCG-refractory NMIBC.
Purpose of the Study:
- To review recent advancements in systemic immunotherapy for BCG-refractory NMIBC.
- To highlight the evolving treatment paradigm for patients with this condition.
Main Methods:
- Review of current literature on systemic immunotherapy in BCG-refractory NMIBC.
- Analysis of emerging treatment strategies and molecular targets.
Main Results:
- Immune checkpoint inhibitors (e.g., pembrolizumab) and gene therapy show therapeutic success and have gained regulatory approval for high-risk BCG-refractory NMIBC.
- Combination regimens involving immunotherapy with intravesical therapy or chemotherapy are under investigation to improve efficacy and overcome resistance.
- Identification of novel molecular targets and development of personalized strategies are rapidly advancing the field.
Conclusions:
- Systemic immunotherapy provides a promising bladder-sparing therapeutic option for patients with BCG-refractory NMIBC.
- These findings support a shift towards individualized and less invasive treatment approaches.
- Further research is needed to optimize outcomes, broaden therapeutic choices, and enhance the quality of life for patients.
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