When are chemotherapies and immunotherapies indicated in the treatment of bladder cancer?

Updated: Feb 23, 2021
  • Author: Kara N Babaian, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Bacillus Calmette-Guérin (BCG) immunotherapy or other intravesical chemotherapies may be used for patients with recurrent disease or those at intermediate risk. Patients at high risk, with T1–high grade or CIS, are advised to undergo intravesical BCG immunotherapy because of the substantial likelihood of disease recurrence and progression. [84, 85, 86, 87, 88, 89]

The EAU guidelines recommend that patients with intermediate- and high-risk tumors receive intravesical BCG after TURBT to reduce the risk of tumor recurrence. For optimal efficacy, BCG must be given on a maintenance schedule; 3-year maintenance is more effective than 1-year to prevent recurrence of high-risk tumors, but not of intermediate-risk tumors. [69]

In May 2016, the US Food and Drug Administration (FDA) granted accelerated approval of atezolizumab, the first cancer immunotherapy that acts as an inhibitor of programmed cell death ligand 1 (PD-L1) for the treatment of urothelial carcinoma. Nivolumab, another PD-L1 inhibitor, was approved by the FDA in February 2017. For more information, see Chemotherapeutic Regimens for Metastatic Bladder Cancer, below.

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