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NMIBC With Roger Li, MD

Urology

Dr. Li is a urologic oncologist at Moffitt Cancer Center whose practice focuses on the treatment of bladder, upper tract urothelial, and prostate cancers. His work has been instrumental in the development of clinical trials in the BCG-unresponsive space. He has authored over 100 peer-reviewed manuscripts and serves as reviewer for many international urologic journals.

Shared Decision-Making and Quality of Life

Dear readers,

Shared decision-making is especially important in the setting of managing recurrent disease following failure of BCG. Traditionally, the standard of care for BCG-unresponsive disease has been radical cystectomy. However, a recent multi-institutional study has demonstrated equipoise between bladder-sparing therapies and radical cystectomy.

Given these findings, as well as the availability of multiple bladder-sparing agents recently approved by the FDA, the use of bladder-sparing agents should be extensively discussed with patients. The choice of BST should be personalized according to tumor and patient characteristics. In addition, due to the modest efficacy of the currently available agents, patients should also be encouraged to continue to enroll in clinical trials investigating the efficacy of promising agents.

Two agents that have recently demonstrated long-term efficacy are TAR-200 and cretostimogene. TAR-200, an intravesical gemcitabine delivery system, was found to have CR of 83.5%, with 82% of the patients maintaining CR after a median follow-up of 9 months. Cretostimogene, an oncolytic adenovirus, was reported to achieve 74.5% CR, with 41% of the patients maintaining CR at 24 months.

Sincerely,
Roger Li, MD

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