1 research outputs found
Novel immunotherapeutic options for BCGâunresponsive highârisk nonâmuscleâinvasive bladder cancer
Abstract Background Highârisk nonâmuscleâinvasive bladder cancer (HRâNMIBC) presents a challenge to many physicians due to its ability to resist Bacillus CalmetteâGuĂ©rin (BCG) intravesical therapy and the substantial rate of progression into muscleâinvasive bladder cancer (MIBC). Patients who are BCGâunresponsive have worse prognosis and thus require further management including radical cystectomy (RC), which significantly impacts quality of life. Moreover, the ongoing worldwide shortage of BCG warrants the need for policies that prioritize drug use and utilize alternative treatment strategies. Hence, there is a significant unmet need for bladder preserving therapy in this subset of patients. Methods To address this issue, we searched the relevant literature in PUBMED for articles published from 2019 through May of 2023 using appropriate keywords. All clinical trials of patients with HRâNMIBC treated with immuneârelated agents were retrieved from clinicaltrials.gov. Findings and Future Perspectives Exploratory treatments for BCGâUnresponsive HRâNMIBC included immune checkpoint inhibitors (ICI), oncolytic viral therapy, cytokine agonists, and other immunomodulators targeting TLR, EpCaM, FGFR, MetAP2, and IDO1. Some combination therapies have been found to work synergistically and are preferred therapeutically over monotherapy. Three drugsâpembrolizumab, valrubicin, and most recently, nadofaragene firadenovecâvncgâhave been FDA approved for the treatment of BCGâunresponsive NMIBC in patients who are ineligible for or decline RC. However, all explored treatment options tend to postpone RC rather than provide longâterm disease control. Additional combination strategies need to be studied to enhance the effects of immunotherapy. Despite the challenges faced in finding effective therapies, many potential treatments are currently under investigation. Addressing the landscape of biomarkers, mechanisms of progression, BCG resistance, and trial design challenges in HRâNMIBC is essential for the discovery of new targets and the development of effective treatments