Targeted Therapy in Non-Muscle Invasive Bladder Cancer-Clinical Updates.

Abstract

Non muscle invasive bladder cancer (NMIBC) comprises almost 75% of all bladder cancer (BC) diagnoses. Longstanding intravesical treatment options include chemotherapy or Bacillus Calmette-Guerin (BCG). However, despite these treatment options, there is a high rate of relapse for NMIBC patients, reaching up to 40-50% for patients with high risk disease. Radical cystectomy is recommended by guideline committees for patients with high risk NMIBC and for patients who fail intravesical treatment options however this is a procedure with high morbidity and many patients are not good candidates or prefer more conservative treatment approaches. Given this and the high failure rates of current therapies, much ongoing research in NMIBC is focused on other bladder sparing treatment modalities. There have been new advances in molecular features of BC with findings of genetic alterations in NMIBC leading way to a rise in precision medicine targeting a patient's individual gene mutation. While data surrounding these targeted therapies in NMIBC specifically are all preliminary, many trials are currently underway derived from success in targeted treatments for locally advanced or metastatic BC. Preliminary results are promising and the targeted therapies for NMIBC are increasing. We performed a PubMed and Medline (OVID) literature review assessing recently published studies on targeted therapy on NMIBC, and an additional search on clinicaltrials.gov for active clinical trials. We report on preliminary outcomes and ongoing later stage trials for targeted therapies in NMIBC and anticipate upcoming promising changes to the treatment landscape.