General Treatment for Non-Muscle-Invasive Bladder Cancer


Sia Daneshmand, MD on the non-muscle invasive bladder cancer treatment paradigm.

Sia Daneshmand, MD, associate professor of urology with Clinical Scholar designation, director of urologic oncology, and clinical research and urologic oncology fellowship director at the Keck School of Medicine of USC, discusses the current treatment options for non-muscle invasive bladder cancer for both responsive and unresponsive patients to bacillus Calmette-Guérin (BCG).

According to Daneshmand, there are limited options for these patients, and the guidelines recommend that oncologists enroll their patients on clinical trials.


0:08 | The general treatment for non-muscle invasive bladder cancer would be a intravesical BCG. That's what we've been relying on for many years. But a significant portion of patients are refractory to BCG and end up having recurrences and more importantly, progression to higher grade and higher-stage disease. So, there is a real unmet need for these patients because we have positive treatment options for these patients.

0:37 | Currently, for patients with BCG-unresponsive or -refractory disease, the guidelines sort of encourage clinical trial enrollment, as our options are somewhat limited. We do have chemotherapy, doublet therapies available to us, which shows some good responses in many patients, but the data is retrospective and we're trying to see what data will show and prospective studies.

1:12 | Also, in this BCG-unresponsive space, we do have pembrolizumab [Keytruda] that was approved a couple of years ago for BCG-refractory carcinoma in situ. And that's used in some settings with some success, but the success rates at one year are rather low, It's 19%. We do need other treatments in this space that are both more efficacious, and with a better duration of response.

1:49 | Also recently, nadofaragene firadenovec [Adstiladrin] was FDA approved in the setting, but we still don't have the drug available to us yet commercially. So again, our options are somewhat limited in the space right now.

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