Recent Advances in Immunotherapy for Non-Muscle-Invasive Bladder Cancer

Area of Science:

• Urology
• Oncology
• Immunotherapy

Background:

• Non-muscle-invasive bladder cancer (NMIBC) accounts for 75% of bladder cancer diagnoses.
• High recurrence and progression rates necessitate intensive surveillance and treatment.
• Bacillus Calmette-Guérin (BCG) is standard for high-risk NMIBC, but shortages and side effects exist.

Purpose of the Study:

• To review advancements in intravesical and systemic immunotherapies for NMIBC.
• To highlight ongoing clinical trials and emerging treatment options.
• To discuss controversies in trial design, sequencing, efficacy, and safety.

Main Methods:

• Narrative review of recent clinical trials and FDA-approved immunotherapies.
• Analysis of treatment outcomes for BCG-unresponsive NMIBC.
• Discussion of therapeutic alternatives to radical cystectomy.

Main Results:

• Several intravesical and systemic immunotherapies have shown efficacy in BCG-unresponsive NMIBC.
• FDA approvals include nadofaragene firadenovec, nogapendekin alfa-inbakicept, and pembrolizumab.
• Ongoing trials continue to expand treatment options and investigate novel combinations.

Conclusions:

• Immunotherapy represents a significant advancement for NMIBC management, particularly for BCG-refractory cases.
• Alternatives to radical cystectomy are crucial given its impact on quality of life.
• Further research is needed to optimize treatment sequencing and comparative efficacy.