Optimal Management of Bacillus Calmette-Guérin–Refractory Non–Muscle-Invasive Bladder Cancer in 2023

Bacillus Calmette-Guérin (BCG)-unresponsive non–muscle-invasive bladder cancer (NMIBC) poses a significant clinical challenge, prompting a need for effective treatment options. Although radical cystectomy is a standard approach, it is burdened by high morbidity, mortality, and adverse effects on patients’ quality of life, necessitating the exploration of alternative bladder preservation strategies. This review presents a diverse range of bladder preservation options to improve outcomes in patients with BCG-unresponsive NMIBC. The interventions discussed include intravesical chemotherapy, device-assisted therapy, immunotherapy with checkpoint inhibitors, antibody-drug conjugates, intravesical gene therapy, and combinations of these treatments.