Prediction of BCG responses in NMIBC in the era of novel immOn top of efficacy ratios, we also have a much clearer (predictable) technology, when you read the following 11-pages article:
And pay attention to Table 1 too.
Urology - Review First Online: 01 June 2019
Full 11 pages article:
Abstract
Bacillus Calmette–Guerin (BCG) instillations are considered as a gold standard of therapy in high- and intermediate-risk non-muscle-invasive bladder cancer (NMIBC). Unfortunately, up to 40% of patients might experience treatment failure and even 15% of patients initially diagnosed with NMIBC will progress to muscle-invasive disease. Since patients, who fail to respond to BCG, are at particular risk of progression, immediate radical cystectomy (RC) is currently recommended to provide cancer control. However, immunotherapy in NMIBC management still evolves. Immune checkpoint inhibitors emerge as new immunotherapeutics, which in the future might be combined with BCG and may serve as an alternative to radical cystectomy in patients, who failed to respond to BCG alone or are at particular a priori risk of BCG failure, especially if RC is not a safe option. Therefore, there is an urgent need to identify NMIBC patients that will not benefit from BCG therapy and demand radical cystectomy. In the following review, we attempt to focus on several clinical and molecular factors and demonstrate the efforts directed to unravel their significance in BCG-failure risk assessment.
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Conclusion
BCG failure in high-risk NMIBC remains enigmatic clinical phenomenon and significant therapeutic problem. Simultaneously, with advances in understanding of tumour microenvironment, emergence of novel therapies targeting immune response is observed. Early identification of individuals who are at particular risk of developing BCG resistance might aid selecting patients who could benefit most from combined treatment. Potentiation of BCG instillations with immune checkpoint inhibition might contribute to reducing overtreatment with radical cystectomy. Clinical trials evaluating such combination therapies are underway, but their exact clinical implementation in NMIBC remains unclear. Although histopathological features are currently the best predictors of recurrence and progression, an urgent need for new predictors of response to BCG remains apparent. Better understanding of BCG resistance pathophysiology might bring development of novel predictive models that can be easily utilized in planning patient-adjusted therapy.