Overcoming Barriers to Progress in Non-muscle Invasive Bladder Cancer - Where Are We In 2018 and Where Will We Be In 5 Years?

At the 3rd Global Congress on Bladder Cancer, Dr. Ashish Kamat outlined the current challenges and future directions in non-muscle invasive bladder cancer (NMIBC). While advances such as immune checkpoint inhibitors have changed the treatment landscape, significant barriers remain.

First, NMIBC is highly heterogeneous, with variant histologies often missed by community pathologists, leading to discrepancies between initial transurethral resections and subsequent radical cystectomies. A lack of standardized definitions for risk groups across guidelines further complicates management. Dr. Kamat proposed a simplified classification: low-risk (small, solitary, Ta low-grade tumors), high-risk (any T1, high-grade, or CIS), and intermediate-risk based on specific clinical factors.

Second, cystoscopy, the gold standard for detection, frequently misses residual or invasive disease. Blue light cystoscopy (Cysview®) has been shown to improve detection rates, extend time to recurrence, and reduce progression risk.

Third, the definition of BCG failure has only recently been standardized, emphasizing the need for adequate induction and maintenance therapy, with the SWOG protocol being the most effective. Clear criteria for BCG failure at six months are essential for treatment planning.

Lastly, predictive markers remain elusive. While clinical factors and some molecular subtypes offer insights, reliable biomarkers are still lacking. Trials such as IMvigor 210 highlight the potential of immunologic markers to identify responders to therapies like atezolizumab.

Dr. Kamat concluded by emphasizing ongoing clinical trials exploring immunologic strategies in NMIBC. Their results, expected in the coming years, may help overcome current barriers and improve patient outcomes.

Goldberg, H. (2018, September 20–21). Overcoming barriers to progress in non-muscle invasive bladder cancer – Where are we in 2018 and where will we be in 5 years? [Conference session summary]. Global Conference on Bladder Cancer, Madrid, Spain. UroToday. https://www.urotoday.com/