(StatePoint) The bladder cancer treatment landscape is rapidly evolving, particularly for patients who don’t respond to bacillus Calmette–Guérin (BCG), the most common intravesical immunotherapy for early-stage bladder cancer.
However, as options expand, clinicians face added complexity in individualizing treatment paths, and in knowing what’s working. Fortunately, during evaluation and follow-up, they can lean on various enhanced diagnostic technologies, including approaches such as Blue Light Cystoscopy (BLC), to support timely adjustments in treatment.
Bladder-Sparing Therapies
Bladder-sparing therapies are offering new treatment avenues, potentially delaying or avoiding cystectomy for some patients. These therapies are aimed at managing the cancer while preventing the need to remove the bladder. Therapies include liquid treatments put directly into the bladder, such as immunotherapy and chemotherapy, biologic agents and gene-based therapies, and devices that support or optimize drug delivery to the bladder lining. Often considered after BCG fails or in patients for whom cystectomy may not be the best choice, most regimens include a series of treatments over time, along with regular cystoscopic evaluations.
Multidisciplinary teams, which could include urologists, medical oncologists, pathologists and oncology nurses, may be involved in planning and monitoring a patient’s treatment. Treatment sequencing typically involves starting with one therapy, then switching therapies if clear evidence suggests a limited response to the treatment. The medical team will assess tumor characteristics, prior treatments, and factors such as the patient’s logistics and goals, to determine the best next step. Ultimately, eligibility for bladder-sparing approaches varies based on the disease profile and available clinical evidence.
Evaluating treatment response in non-muscle invasive bladder cancer (NMIBC) often relies on cystoscopic findings that may be subtle or difficult to interpret. BLC however, is an enhanced visualization technique that uses an optical imaging agent and a combination of white and blue light to highlight abnormal bladder tissue, supporting clinicians in assessing the bladder lining and providing insight into treatment effectiveness.
Although this diagnostic method does not treat or prevent disease, it does offer numerous benefits. It can define the borders of lesions during transurethral resection of bladder tumors (TURBTs) and support visualization during routine surveillance cystoscopies. And because it can be used to evaluate whether BCG or subsequent therapies are achieving their intended responses, it can enable doctors to quickly decide whether they should continue treatment as-is, make adjustments, or move to other therapies. Additionally, BLC helps document baseline disease features prior to starting therapy, may improve visual assessment of tissue changes over time, and aids in guiding tissue sampling, ensuring all visible tumors are identified and removed during procedures like TURBT.
With enhanced visualization, patients and their care teams can have more informed discussions about results and next steps.
Patients seeking productive discussions with their healthcare team can start by asking the following questions:
• How quickly can decisions be made to adjust therapies if BCG doesn’t work, and what treatments might be appropriate?
• How do you evaluate whether a therapy is doing what it should?
• Would enhanced imaging be helpful?
• What’s the plan if this approach doesn’t show the desired results?
Bladder-sparing strategies are creating more personalized options for patients, and enhanced diagnostic tools are helping lead the way. Patients should never hesitate to ask their team how they use diagnostic tools to guide care, and what their options look like based on their specific case.
Sponsored by Photocure, Inc.
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