Szabados Bernadett E, Guerrero-Ramos Félix, Grande Enrique, Grivas Petros, Grünwald Viktor, Miguel Marta Carpintero, Hussain Syed A, Kulkarni Girish S, Wilson Ana Lisa, Shore Neal D, Sridhar Srikala S, Hoyt Mary, Strumeier Samantha, Sutton Jennifer, Brinkmann Julia, Teresi Rosemary E, Todenhöfer Tilman
Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
University College London Hospital NHS Foundation Trust, London, UK.
Oncol Ther. 2025 Apr 17. doi: 10.1007/s40487-025-00334-6.
Patients with high-risk non-muscle invasive bladder cancer (NMIBC) are generally treated with transurethral resection of the bladder tumor followed by intravesical bacillus Calmette-Guérin (BCG), the current standard of care. However, recurrence or progression is common and may result in patients requiring radical cystectomy. Additionally, BCG continues to be in short supply worldwide. Therefore, there is an unmet need for new therapies that provide durable disease control and maintain quality of life. In the BCG-naïve high-risk NMIBC setting, potential new treatment options are emerging, with several regimens combining intravesical therapy with systemic PD-1 or PD-L1-directed immune checkpoint inhibitors (ICIs) currently under investigation in several Phase 3 trials. In routine clinical practice, NMIBC has traditionally been managed almost entirely by urologists. However, the introduction of systemic ICIs would likely require medical oncology expertise to help assess patients' fitness for these therapies and potentially for treatment administration and immune-related adverse event management. While multidisciplinary workflows are common practice for advanced bladder cancer, they would represent a paradigm shift in NMIBC. Based on current experience of managing patients with NMIBC across different countries and healthcare systems from our perspective as urologists, medical oncologists, and nurses, we discuss best practices for the potential integration of emerging therapies such as ICIs into the treatment of BCG-naïve high-risk NMIBC. We emphasize the need for multidisciplinary care, either through formalized multidisciplinary teams or cross-discipline collaborative workflows adapted to local needs, to ensure efficient coordination and sharing of responsibilities. Specialized nurses have the potential to play key roles across multiple aspects of patient care. We also highlight the crucial importance of effective communication across teams, increases in resourcing, and education for healthcare professionals, patients, and caregivers to enable eligible patients with high-risk NMIBC to benefit optimally from the introduction of these potential new treatment options. Supplementary file2 (MP4 407382 kb).
高危非肌层浸润性膀胱癌（NMIBC）患者通常先接受经尿道膀胱肿瘤切除术，然后进行膀胱内卡介苗（BCG）灌注，这是目前的标准治疗方法。然而，复发或进展很常见，可能导致患者需要进行根治性膀胱切除术。此外，BCG在全球范围内仍然供应短缺。因此，迫切需要新的治疗方法来实现持久的疾病控制并维持生活质量。在未接受过BCG治疗的高危NMIBC患者中，新的潜在治疗选择不断涌现，目前有几种将膀胱内治疗与全身性PD-1或PD-L1导向的免疫检查点抑制剂（ICI）联合使用的方案正在多项3期试验中进行研究。在常规临床实践中，NMIBC传统上几乎完全由泌尿科医生管理。然而，引入全身性ICI可能需要肿瘤内科专业知识，以帮助评估患者是否适合这些治疗，以及可能的治疗实施和免疫相关不良事件管理。虽然多学科工作流程是晚期膀胱癌的常见做法，但它们将代表NMIBC治疗的范式转变。基于我们作为泌尿科医生、肿瘤内科医生和护士在不同国家和医疗保健系统中管理NMIBC患者的当前经验，我们讨论了将ICI等新兴疗法潜在整合到未接受过BCG治疗的高危NMIBC治疗中的最佳实践。我们强调需要通过正式的多学科团队或根据当地需求调整的跨学科协作工作流程进行多学科护理，以确保高效的协调和责任分担。专科护士有可能在患者护理的多个方面发挥关键作用。我们还强调了团队间有效沟通、增加资源以及对医疗保健专业人员、患者和护理人员进行教育的至关重要性，以使符合条件的高危NMIBC患者能够从这些潜在的新治疗选择中获得最大益处。补充文件2（MP4 407382 kb）。
