Sam Chang hosts Neal Shore to discuss the evolving guidelines for high-risk, non-muscle invasive bladder cancer. Dr. Shore defines high-risk disease as CIS, T1 invasion, and high-grade papillary tumors, with very high-risk features including prostatic urethral involvement. For BCG unresponsive patients, the field now offers numerous therapies beyond traditional radical cystectomy. Two FDA-approved intravesical immunotherapies are available: nadofaragene firadenovec and nogapendekin. Dr. Shore emphasizes the importance of shared decision-making, noting that while no head-to-head comparisons exist, both agents show promising efficacy with manageable tolerability profiles. He advocates for guidelines committees to recognize high-quality single-arm studies, especially given the rapidly evolving treatment landscape.

Biographies:

Neal Shore, MD, FACS, Director, CPI (Certified Principal Investigator by the Association of Clinical Research Professionals), Medical Director, Carolina Urologic Research Center and the START Cancer Research Institute, AUC Urology Specialists, Myrtle Beach, SC

Sam S. Chang, MD, MBA, Urologist, Patricia and Rodes Hart Professor of Urologic Surgery, Vanderbilt University Medical Center, Chief Surgical Officer, Vanderbilt-Ingram Cancer Center, Nashville, TN