Félix Guerrero-Ramos, Carmen Gómez-Cañizo, Mario Hernández-Arroyo, José Daniel Subiela, Benjamin Pradere, Evangelos Xylinas, Alfredo Rodríguez-Antolín
{"title":"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。","authors":"Félix Guerrero-Ramos, Carmen Gómez-Cañizo, Mario Hernández-Arroyo, José Daniel Subiela, Benjamin Pradere, Evangelos Xylinas, Alfredo Rodríguez-Antolín","doi":"10.1097/MOU.0000000000001329","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose of review: </strong>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.</p><p><strong>Recent findings: </strong>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.</p><p><strong>Summary: </strong>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.</p>","PeriodicalId":11093,"journal":{"name":"Current Opinion in Urology","volume":" ","pages":"620-628"},"PeriodicalIF":2.2000,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Hyperthermic intravesical chemotherapy for Bacillus Calmette-Guérin-unresponsive nonmuscle-invasive bladder cancer.\",\"authors\":\"Félix Guerrero-Ramos, Carmen Gómez-Cañizo, Mario Hernández-Arroyo, José Daniel Subiela, Benjamin Pradere, Evangelos Xylinas, Alfredo Rodríguez-Antolín\",\"doi\":\"10.1097/MOU.0000000000001329\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose of review: </strong>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.</p><p><strong>Recent findings: </strong>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.</p><p><strong>Summary: </strong>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.</p>\",\"PeriodicalId\":11093,\"journal\":{\"name\":\"Current Opinion in Urology\",\"volume\":\" \",\"pages\":\"620-628\"},\"PeriodicalIF\":2.2000,\"publicationDate\":\"2025-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Current Opinion in Urology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/MOU.0000000000001329\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/8/13 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Current Opinion in Urology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/MOU.0000000000001329","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/8/13 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
Hyperthermic intravesical chemotherapy for Bacillus Calmette-Guérin-unresponsive nonmuscle-invasive bladder cancer.
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.
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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