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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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.

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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。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

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.