Hyperthermic intravesical chemotherapy for Bacillus Calmette-Guérin-unresponsive nonmuscle-invasive bladder cancer.

IF 2.2 3区 医学 Q2 UROLOGY & NEPHROLOGY
Current Opinion in Urology Pub Date : 2025-11-01 Epub Date: 2025-08-13 DOI:10.1097/MOU.0000000000001329
Félix Guerrero-Ramos, Carmen Gómez-Cañizo, Mario Hernández-Arroyo, José Daniel Subiela, Benjamin Pradere, Evangelos Xylinas, Alfredo Rodríguez-Antolín
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引用次数: 0

Abstract

Purpose of review: Hyperthermic intravesical chemotherapy (HIVEC) and other device-assisted platforms are emerging bladder-sparing options after Bacillus Calmette-Guérin (BCG) failure in nonmuscle-invasive bladder cancer (NMIBC). This review integrates recent mechanistic, clinical and economic evidence to clarify their therapeutic position.

Recent findings: Prospective and real-world series in BCG-unresponsive disease report complete response rates of 40-60% for carcinoma in situ and 35-70% 12-24-month high-grade recurrence-free survival for papillary tumors. Radiofrequency-induced thermo-chemotherapy, recirculant chemohyperthermia and electromotive drug administration achieve comparable efficacy. Toxicity is usually grade 1-2 urinary urgency, frequency or dysuria, with serious events in fewer than 10% of patients. Health-economic modelling suggests HIVEC becomes cost-effective once high-grade recurrence-free survival exceeds 30% at 12 months.

Summary: Device-assisted hyperthermic chemotherapy combines biological plausibility, acceptable safety and favorable cost, positioning it as a potential option between BCG failure and radical cystectomy. Ongoing phase III trials will determine long-term oncological control, refine patient selection and optimize sequencing with systemic and intravesical agents.

卡尔梅芽孢杆菌-谷氨酰胺-无反应的非肌肉浸润性膀胱癌的膀胱内热化疗。
回顾目的:在非肌肉浸润性膀胱癌(NMIBC)患者卡介苗(BCG)治疗失败后,热膀胱内化疗(HIVEC)和其他器械辅助平台正在成为保膀胱的新选择。这篇综述整合了最近的机制,临床和经济证据,以澄清其治疗地位。最近的研究结果:bcg无反应疾病的前瞻性和现实世界系列报告,原位癌的完全缓解率为40-60%,乳头状肿瘤的12-24个月高级别无复发生存率为35-70%。射频诱导热化疗、循环化疗热疗和电动势给药的疗效相当。毒性通常为1-2级尿急、尿频或排尿困难,不到10%的患者发生严重事件。健康经济模型表明,一旦12个月时高级别无复发生存率超过30%,HIVEC就具有成本效益。摘要:器械辅助热化疗具有生物学合理性、可接受的安全性和有利的成本,是介于卡介苗失败和根治性膀胱切除术之间的潜在选择。正在进行的III期试验将确定长期的肿瘤控制,细化患者选择,并优化系统和体内药物的测序。
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来源期刊
Current Opinion in Urology
Current Opinion in Urology 医学-泌尿学与肾脏学
CiteScore
5.00
自引率
4.00%
发文量
140
审稿时长
6-12 weeks
期刊介绍: ​​​​​​​​Current Opinion in Urology delivers a broad-based perspective on the most recent and most exciting developments in urology from across the world. Published bimonthly and featuring ten key topics – including focuses on prostate cancer, bladder cancer and minimally invasive urology – the journal’s renowned team of guest editors ensure a balanced, expert assessment of the recently published literature in each respective field with insightful editorials and on-the-mark invited reviews.
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