Amit Gupta, MD, urologic oncologist, Department of Surgery, Cedars-Sinai Medical Center, discusses how the use of immunotherapy agents is altering the role of surgery in bladder cancer and the need for Bacillus Calmette-Guérin (BCG) alternatives.

Right now, immunotherapy agents are not affecting surgery. The treatment paradigm for the patient who has failed BCG is typically cystectomy. If immunotherapy agents are proven to be effective for patients with BCG-unresponsive or BCG-refractory nonmuscle-invasive bladder cancer (NMIBC), surgery would be used later rather than earlier.

Now, the biggest unmet need is finding an alternative to BCG. A lot of patients who need cystectomy after failing intravesical therapy start with NMIBC. While they're getting intravesical therapy, the disease progresses to muscle-invasive bladder cancer; that’s when they require cystectomy. If we can get more effective options to either enhance BCG, replace BCG, or be an option after it, we can help our patients avoid a morbid surgery, or its alternatives, says Gupta.

Amit Gupta, MD

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