Innovative Tratments of Non Muscle Invasive Bladder Cancer

Abstract

Bladder cancer represents the second most common neoplasm of the urinary tract and the fourth in general among all the neoplastic pathologies for the male gender; in females, it is the eighth most frequent among all cancers. At the initial diagnosis, 70% of bladder tumors are non-muscle invasive. Treatment of this stage is multimodal, both surgical and pharmacological; the aim is not only to remove the tumor completely but also to prevent tumor recurrence and to inhibit its progression. The treatment for non-muscle invasive bladder cancer is a current topic in the scientific community and it is represented by the endoscopic resection of the tumor, which is generally followed by the adjuvant intravesical treatment with chemotherapy or immunotherapy agents, according to the different risk groups. Benefits and limits of intravesical therapies have been known for long; the aim of this study is to present new drugs or new treatment patterns which could emerge as a valid therapeutic alternative to conventional treatments, given the fact that, regardless of the type of treatment, 2/3 of the patients with a diagnosis of non-muscle invasive bladder cancer have a disease recurrence, and the 10–20% of these show a progression to a muscle-invasive tumor. Furthermore, the failure of intravesical therapy implies another therapeutic option, such as radical cystectomy for non-muscle invasive bladder cancer. According to this fact, new strategies include the activation of host immune system and the optimization of cytotoxic effects of chemotherapeutic drugs. Although most of these studies are still in a pre-clinical phase, the experimental outcomes and the initial results in humans are encouraging.