Popli Swati, Durant Adri M, Tyson Mark, Singh Parminder
Mayo Clinic, (Medical Oncology), Phoenix, (Arizona), USA.
Mayo Clinic, (Urology), Phoenix, (Arizona), USA.
Curr Oncol Rep. 2025 Apr 30. doi: 10.1007/s11912-025-01657-3.
In recent years, new, effective bladder sparing techniques have emerged as favorable options for patients with BCG-unresponsive high-grade non-muscle-invasive bladder cancer (NMIBC) and localized muscle-invasive bladder cancer (MIBC), leading to a paradigm shift from the traditional radical cystectomy in clinical practice. Our aim is to examine the evolution of these techniques, summarize the current evidence, and shed light on the future of these treatment options.
Bladder preservation techniques offer a patient-centered approach while also demonstrating non-inferiority to radical cystectomy in terms of survival outcomes for both NMIBC and MIBC patients. Approved novel therapies, including systemic pembrolizumab and intravesical agents such as nadofaragene, nogapendekin alfa inbakicept, and cretostimogene grenadenorepvec, have shown promising results for BCG-unresponsive NMIBC patients. For carefully selected MIBC patients, Trimodal Therapy (TMT) remains an effective alternative. However, the consensus on the addition of neoadjuvant chemotherapy to TMT and the choice of radio-sensitizing chemotherapy / fractionation schedule of radiation therapy is still under investigation. Additionally, immunotherapy in BCG-naïve patients and as part of concurrent chemoradiotherapy regimens in MIBC patients offers favorable early results. Bladder preservation is a feasible and increasingly preferred alternative in certain NMIBC and MIBC patients who are either unfit or unwilling for radical cystectomy. Promising novel therapies, such as immunotherapy, recombinant intravesical therapies, and antibody-drug conjugates are emerging as potential alternatives. These therapies aim to achieve good oncological outcomes while maintaining quality of life, providing an alternative to the decades long standard of care.
近年来，新的有效膀胱保留技术已成为卡介苗无反应性高级别非肌层浸润性膀胱癌（NMIBC）和局限性肌层浸润性膀胱癌（MIBC）患者的有利选择，导致临床实践中从传统根治性膀胱切除术的模式发生转变。我们的目的是研究这些技术的发展，总结当前证据，并阐明这些治疗选择的未来。
膀胱保留技术提供了以患者为中心的方法，同时在NMIBC和MIBC患者的生存结果方面也显示出不劣于根治性膀胱切除术。已获批的新型疗法，包括全身用派姆单抗和膀胱内用药如纳多法吉尼、诺加彭德金α、因巴西普和克瑞托司基因格拉纳诺瑞普韦，已显示出对卡介苗无反应的NMIBC患者有前景的结果。对于精心挑选的MIBC患者，三联疗法（TMT）仍然是一种有效的替代方法。然而，关于在TMT中添加新辅助化疗以及放射增敏化疗/放射治疗分割方案的选择仍在研究中。此外，在初治卡介苗的患者中以及作为MIBC患者同步放化疗方案的一部分进行免疫治疗可提供良好的早期结果。在某些不适合或不愿意接受根治性膀胱切除术的NMIBC和MIBC患者中，膀胱保留是一种可行且越来越受青睐的替代方法。有前景的新型疗法，如免疫疗法、重组膀胱内疗法和抗体药物偶联物正在成为潜在的替代方法。这些疗法旨在在维持生活质量的同时实现良好的肿瘤学结果，为长达数十年的标准治疗提供了替代方案。
