Current treatments for BCG failure in non-muscle invasive bladder cancer (NMIBC)
Por:
Alvarez-Maestro, M, Guerrero-Ramos, F, Rodriguez-Faba, O, Dominguez-Escrig, JL, Fernandez-Gomez, JM
Publicada:
1 mar 2021
Ahead of Print:
1 mar 2021
Resumen:
The treatment of choice for high-risk non-muscle invasive bladder cancer (NMIBC) is bacillus Calmette-Guerin (BCG). However, when this fails, the indicated treatment is radical cystectomy. In recent years, trials are being developed with various drugs to avoid this surgery in patients with BCG failure. The aim of this article is to update the treatments under study for bladder preservation in this patient population. Non-systematic review, searching PubMed with the terms "Bladder cancer", "Non-muscle invasive bladder cancer", "NMIBC", "BCG", "BCG-refractory", "Mitomycin C", "MMC", "Hyperthermia", "Electromotive Drug Administration", "EMDA". We used the search engines clinicaltrials.gov and clinicaltrialsregister.eu to find clinical trials. The only intravesical drug approved by the Food and Drug Administration (FDA) for carcinoma in situ (CIS) after failure to BCG is Valrubicin. Recently, the FDA has approved intravenous Pembrolizumab, following the publication of preliminary data from the KEYNOTE-057 study. Atezolizumab has demonstrated similar preliminary efficacy results. Only microwave-induced chemohyperthermia and EMDA-MMC (Electromotive Drug Administration) are recognized as alternatives in European guidelines. Other options under investigation are taxanes and gemcitabine, alone or in combination, recombinant viruses and device-assisted intravesical chemohyperthermia. The results of new drugs are promising, with a large number of trials underway. Knowing the mechanisms of resistance to BCG is essential to explore new therapeutic options. (C) 2020 AEU. Published by Elsevier Espana, S.L.U. All rights reserved.
Filiaciones:
Alvarez-Maestro, M:
Hosp Univ La Paz, Dept Urol, Madrid, Spain
Guerrero-Ramos, F:
Hosp Univ 12 Octubre, Dept Urol, Madrid, Spain
Rodriguez-Faba, O:
Fundacio Puigvert, Dept Urol, Barcelona, Spain
Dominguez-Escrig, JL:
Inst Valenciano Oncol IVO, Dept Urol, Valencia, Spain
Fernandez-Gomez, JM:
Hosp Univ Cent Asturias, Dept Urol, Oviedo, Spain
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