Intravesical Therapies in Non-muscle Invasive Bladder Tumors

In the European Association of Urology (EAU) 2015 Guidelines for non-muscle invasive bladder tumors, maintenance Bacillus Calmette-Guerin (BCG) therapy is a grade A recommendation. In the intermediate-risk group, re-evaluation is recommended after 1-year full-dose treatment; in the highrisk group, full-dose BCG is recommended for 1-3 years. Intravesical BCG therapy fails in 40% patients in an average of 2 years. In these cases, there is no alternative treatment that is considered effective. In patients with failed BCG, comparison of BCG and gemcitabine showed less recurrence in the long term with gemcitabine while progression and toxicity were similar. Early radical cystectomy should be considered in non-muscle invasive bladder cancer patients with BCG-refractory T1G3 who have good performance status and low comorbidity. In T1 tumors, invade deeper than 3 mm and/or larger than 6 mm in diameter has been associated with a 100% progression rate. BCG decreased recurrence more significantly in high-risk Ta and T1 tumors. In terms of progression of high-risk superficial bladder cancer, comparison of mitomycin C and BCG showed that BCG is superior if maintenance therapy is given. EAU guidelines recommend early bladder chemotherapy instillation (EBCI), in the low-to-intermediate risk group. There was no clear effect of EBCI in the intermediate-and high-risk group. EBCI alone reduces recurrence only in the low-risk group. However, adjuvant intravesical chemotherapy (AIVC) is recommended in the intermediate-and high-risk groups because it improves relapse-free survival. BCG and maintenance BCG therapy were found to be more effective than AIVC in reducing progression and preventing recurrence.