In the last decade, treatment options for NMIBC and MIBC have seen significant advancements, especially for patients who are ineligible for cisplatin-based chemotherapy. However, a pressing challenge remains: the shortage of intravesical bacillus Calmette-Guérin (BCG). This essential treatment for NMIBC has resulted in delays and increased dependence on alternative therapies that may be less effective, underscoring the need for innovative solutions to enhance local therapy efficacy and reduce recurrence and progression rates.
The article categorizes several promising advancements in treatment delivery mechanisms. For instance, intravesical antibody-drug conjugates including enfortumab vedotin are currently under investigation in early phase trials for intravesical administration in patients with high-risk BCG-unresponsive disease. Oncolytic gene therapies like cretostimogene grenadenorepvec (CG0070) and nadofaragene firadenovec are making headlines in the BCG-unresponsive space, with FDA approval of Nadofaragene Firadenovec for high-risk BCG-unresponsive NMIBC obtained in December 2022.
The GemRIS TAR-200 device stands out by providing continuous gemcitabine release and has been under investigation in the NMIBC space as well as in late phase trials for MIBC in the neoadjuvant setting and for patients who are unfit for or refuse radical cystectomy. This article underlines the importance of refining patient selection for novel therapies in MIBC to avoid undertreatment. Moreover, innovative approaches like reverse-thermal gels and chemo hyperthermia are being explored for their potential to enhance drug delivery and treatment efficacy.
Nanotechnology emerges as an innovative concept in early exploratory studies, particularly through the use of nanoparticles for targeted drug delivery. Studies involving nab-paclitaxel have shown promise in treating recurrent NMIBC, though long-term outcomes are still being evaluated. The article also discusses ADCs, including enfortumab vedotin and vicinium, which are under investigation for NMIBC and highlights the potential of subcutaneous therapies like envafolimab, which may offer easier administration compared to traditional intravenous options.
This article seeks to emphasize the rapid advancements in bladder cancer treatment and the critical need for optimized drug delivery mechanisms to boost efficacy while minimizing side effects. Ongoing clinical trials are essential to substantiate the promising results of these novel therapies and their delivery methods. This exploration of innovative approaches illustrates the dynamic nature of bladder cancer management and the potential for significantly improved patient outcomes in the future.
Written by:
- Mira Patel, MD, MDPGY-1, Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, WA
- JJ Zhang, MD, Department of Urology, UCLA Medical Center, Los Angeles, CA
- Karim Chamie, MD, Department of Urology, UCLA Medical Center, Los Angeles, CA, USA.