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Immune Therapies in Non-Muscle Invasive Bladder Cancer

  • Genitourinary Cancers (W Oh and M Galsky, Section Editors)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Non-muscle invasive bladder cancer (NMIBC) continues to be a challenging disease to manage. Treatment involves transurethral resection and, often, intravesical therapy. Appropriate patient selection, accurate staging, and morphological characterization are vital in risk-stratifying patients to those who would most benefit from receiving intravesical therapy. Bacillus of Calmette and Guérin (BCG) continues to be the first-line agent of choice for patients with intermediate- and high-risk NMIBC. Treatment should begin with the standard induction course of 6 weekly treatments. The inclusion of subsequent maintenance courses of BCG is imperative to optimal therapeutic response. While patients with intermediate-risk disease should receive 1 year of maintenance therapy, high-risk patients benefit from up to 3 years of maintenance therapy. BCG use should not be used in low-risk patients with de novo Ta, low-grade, solitary, <3-cm tumors. Conversely, patients with muscle-invasive disease should forgo intravesical immunotherapy and proceed directly to radical cystectomy. Cystectomy also should be considered in patients with multiple T1 tumors, T1 tumors located in difficult to resect locations, residual T1 on re-resection, and T1 with concomitant CIS. Although promising new immunotherapeutic agents, such as Urocidin, protein-based vaccines, and immune check point inhibitors are undergoing preclinical and clinical investigation, immunotherapy in bladder cancer remains largely reliant on intravesical BCG with surgical consolidation as the standard salvage treatment for patients with BCG failure.

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Conflict of Interest

Philip L. Ho, Stephen B. Williams declare that they have no conflict of interest. Ashish M. Kamat received research funding and serves as consultant to Sanofi, Merck, Bioniche, FKD Therapeutics.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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  1. The University of Texas at M.D. Anderson Cancer Center, Houston, TX, USA

    Philip L. Ho MD, Stephen B. Williams MD & Ashish M. Kamat MD, MBBS, FACS

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  1. Philip L. Ho MD
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  2. Stephen B. Williams MD
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  3. Ashish M. Kamat MD, MBBS, FACS
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Correspondence to Ashish M. Kamat MD, MBBS, FACS.

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This article is part of the Topical Collection on Genitourinary Cancers

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Ho, P.L., Williams, S.B. & Kamat, A.M. Immune Therapies in Non-Muscle Invasive Bladder Cancer. Curr. Treat. Options in Oncol. 16, 5 (2015). https://doi.org/10.1007/s11864-014-0315-3

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