Purpose: Bacillus Calmette–Guérin (BCG) has long been the standard treatment for preventing recurrence and progression following resection of high-risk non-muscle invasive bladder cancer (NMIBC). Unfortunately, recurrence or progression despite BCG induction and maintenance treatment have significant prevalence—a persistent issue in urologic oncology. Notable advancements in the development of alternative therapeutic options have become available and are in the pipeline. This review aims to provide an overview of the current treatment landscape for patients with BCG-unresponsive NMIBC, highlighting both existing and emerging therapies that are expected to become more widely available. Methods: A narrative review based on data collected through the end of 2024. Results: Several treatment options, aside from radical cystectomy (RC), are currently available or in promising stages of clinical trials. Many of these treatment modalities were granted Fast Track and Breakthrough Therapy status due to their initial success. These include novel chemotherapy regimens, immune checkpoint inhibitors, device-assisted therapies, and new intravesical and systemic agents. Combination therapies combining traditional treatments and newer approaches were explored. Conclusions: The next few years promise to offer patients a variety of new, effective therapies for BCG-unresponsive NMIBC. These advancements hold significant potential for improving patient outcomes and providing more targeted, organ-sparing treatment options.
目的：卡介苗（BCG）长期以来一直是预防高危非肌层浸润性膀胱癌（NMIBC）切除术后复发和进展的标准疗法。然而，尽管进行了BCG诱导和维持治疗，复发或进展仍具有显著发生率——这是泌尿肿瘤学中长期存在的难题。近年来，替代治疗方案的发展取得了显著进展，多种新型疗法已进入临床应用或研发阶段。本综述旨在概述当前针对BCG无应答NMIBC患者的治疗格局，重点介绍现有及新兴的治疗方法，这些疗法预计将得到更广泛的应用。方法：基于截至2024年底收集的数据进行叙述性综述。结果：除根治性膀胱切除术（RC）外，目前已有多种治疗方案进入临床应用或处于临床试验阶段。许多治疗方式因其初步疗效获得了快速通道和突破性疗法认定，包括新型化疗方案、免疫检查点抑制剂、设备辅助疗法以及新型膀胱内和全身给药药物。研究还探索了传统疗法与新型方法的联合治疗方案。结论：未来几年将为BCG无应答NMIBC患者提供多种新型有效疗法。这些进展有望显著改善患者预后，并提供更具针对性、保留器官功能的治疗选择。
Therapeutic Advances in Bladder Preservation for BCG-Unresponsive Non-Muscle Invasive Bladder Cancer
肿瘤(癌症)患者之家