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GU Cancers 2026 | Evolving management of high-risk BCG-unresponsive NMIBC

Felix Guerrero-Ramos, MD, PhD, Hospital Universitario 12 de Octubre in Madrid, Spain, comments on the current treatment landscape for high-risk non-muscle-invasive bladder cancer (NMIBC), highlighting the standard of care for BCG unresponsive carcinoma in situ (CIS) and the potential benefits of combination therapies in reducing high-grade recurrences and the need for radical cystectomy. Approved therapies for CIS BCG unresponsive are limited in some countries, and radical cystectomy remains a common approach for these patients. This interview took place at the 2026 ASCO GU Cancers Symposium in San Francisco, CA.

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Transcript

Well, it is true that we know that a high-risk recurrence during or shortly after BCG is equal to radical cystectomy. But, however, we have several approved therapies for CIS BCG unresponsive in the U.S., no therapies for papillary only, or no therapies for CIS BCG unresponsive in other countries, and radical cystectomy still remains the standard of care for these patients...

Well, it is true that we know that a high-risk recurrence during or shortly after BCG is equal to radical cystectomy. But, however, we have several approved therapies for CIS BCG unresponsive in the U.S., no therapies for papillary only, or no therapies for CIS BCG unresponsive in other countries, and radical cystectomy still remains the standard of care for these patients. It is also true that if we, with the combination in the upfront line for BCG-naive, high-risk non-muscle-invasive cancer, if we are achieving less high-grade recurrences and we are avoiding high-grade recurrences, there will be less patients who should be submitted to a radical cystectomy or to one of these new therapies.

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