Bladder cancer is a common malignancy accounting for 5–10% of all male cancers in the Western world. From diagnosis until death, it is the most expensive cancer to treat. The main reason for this is that approximately 80% of cases are non-muscle-invasive bladder cancer (NMIBC). The natural history of NMIBC is primarily of frequent local recurrences within the bladder, with a minority of cases progressing to muscle-invasive disease. Thus, patients with NMIBC require expensive, prolonged and often life-long cystoscopic bladder surveillance at a great expense. Surgical resection of NMIBC using transurethral resection of bladder tumour (TURBT) alone is associated with high rates of recurrence and progression. At the same time, the bladder is uniquely located to allow easy and safe local administration of therapeutic agents via a catheter. Since the 1960s, a number of therapeutic strategies have been used. First, a variety of established systemic chemotherapy drugs have been used as intravesical chemotherapy (IVC). More recently, Bacillus Calmette-Guerin (BCG) has been used as intravesical immunotherapy. Large randomised trials have confirmed that intravesical therapies are effective at reducing the recurrence rate of NMIBC. The effect of therapy on progression, at least in the long term, is less clear. In the last few years, there have been significant advances in intravesical therapy for NMIBC. There is increasing evidence that the effectiveness of intravesical chemotherapy may be improved by physical and chemical optimisation of its administration. The toxicity of intravesical immunotherapy may be improved by dose reduction or shortening treatment time whilst maintaining its effectiveness. Finally, combinations of chemo- and immunotherapy appear promising. A number of new therapeutic agents such as the immune checkpoint inhibitors (ICIs) have undergone phase I and II testing in NMIBC. The results of these trials are eagerly awaited but will need to be replicated in large phase III studies. Until these results are available, current research is primarily focused on increasing the effectiveness of the current therapies. Strategies include increasing the permeability of the bladder wall to chemotherapy drugs using hyperthermia, electromotive drug administration (EMDA) and chemical manipulation. Finally, the ease of access to the bladder for therapy has led to experimental work on gene therapy as a therapeutic option for bladder cancer. This work has focused on attempts to either correct genetic abnormalities or to switch cancer cells to cell death.

Adjuvant Therapy

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发表日期：

2025年

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A. H. Mostafid

摘要

Bladder cancer is a common malignancy accounting for 5–10% of all male cancers in the Western world. From diagnosis until death, it is the most expensive cancer to treat. The main reason for this is that approximately 80% of cases are non-muscle-invasive bladder cancer (NMIBC). The natural history of NMIBC is primarily of frequent local recurrences within the bladder, with a minority of cases progressing to muscle-invasive disease. Thus, patients with NMIBC require expensive, prolonged and often life-long cystoscopic bladder surveillance at a great expense. Surgical resection of NMIBC using transurethral resection of bladder tumour (TURBT) alone is associated with high rates of recurrence and progression. At the same time, the bladder is uniquely located to allow easy and safe local administration of therapeutic agents via a catheter. Since the 1960s, a number of therapeutic strategies have been used. First, a variety of established systemic chemotherapy drugs have been used as intravesical chemotherapy (IVC). More recently, Bacillus Calmette-Guerin (BCG) has been used as intravesical immunotherapy. Large randomised trials have confirmed that intravesical therapies are effective at reducing the recurrence rate of NMIBC. The effect of therapy on progression, at least in the long term, is less clear. In the last few years, there have been significant advances in intravesical therapy for NMIBC. There is increasing evidence that the effectiveness of intravesical chemotherapy may be improved by physical and chemical optimisation of its administration. The toxicity of intravesical immunotherapy may be improved by dose reduction or shortening treatment time whilst maintaining its effectiveness. Finally, combinations of chemo- and immunotherapy appear promising. A number of new therapeutic agents such as the immune checkpoint inhibitors (ICIs) have undergone phase I and II testing in NMIBC. The results of these trials are eagerly awaited but will need to be replicated in large phase III studies. Until these results are available, current research is primarily focused on increasing the effectiveness of the current therapies. Strategies include increasing the permeability of the bladder wall to chemotherapy drugs using hyperthermia, electromotive drug administration (EMDA) and chemical manipulation. Finally, the ease of access to the bladder for therapy has led to experimental work on gene therapy as a therapeutic option for bladder cancer. This work has focused on attempts to either correct genetic abnormalities or to switch cancer cells to cell death.