Device-Assisted Therapy in Non-Muscle-Invasive Bladder Cancer

Abstract

Intravesical therapy is a critical component in the management of non-muscle-invasive bladder cancer (NMIBC), as it reduces rates of disease recurrence and progression. However, the presence of physiologic barriers in the urothelium reduces the penetration and distribution of intravesical chemotherapy, thereby limiting the therapeutic potential. Much progress to overcome this challenge has been made in the realm of intravesical device-assisted therapy. Novel device-assisted treatments include hyperthermia, the radiofrequency-induced thermochemotherapy effect, electromotive drug administration, and implantable drug delivery systems. Notably, chemotherapy enhanced by these device-assisted systems has shown improved oncologic efficacy relative to standard intravesical chemotherapy and comparable outcomes relative to Bacillus Calmette-Guérin (BCG) therapy in patients with intermediate- or high-risk NMIBC. Recent studies also support the utility of device-assisted therapy as a salvage treatment option in patients with BCG-unresponsive disease. Ongoing randomized controlled trials and prospective investigations will further help clarify indications and long-term safety outcomes of these treatment modalities in NMIBC. Herein, we present a comprehensive review of device-assisted therapies and discuss their clinical utilities for the management of NMIBC in the modern era.

Keywords: Non-muscle-invasive bladder cancer; and drug delivery; electromotive drug administration; hyperthermia; intravesical chemotherapy; radiofrequency-induced thermochemotherapy.

Fig. 1

General mechanisms of action for devices used to administer intravesical therapies in non-muscle-invasive bladder cancer. Hyperthermia-based approaches induce regional changes at the molecular level and in the tissue microenvironment, intravesical electromotive drug administration (EMDA) devices induce electrokinetic changes that facilitate drug movement, and implantable drug delivery systems facilitate sustained drug release.