Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Clinical Outlook
  • Published:

Clinical trial design for non-muscle-invasive bladder cancer

The heterogeneous nature of non-muscle-invasive bladder cancer is a challenge for clinical trial design. Careful consideration in clinical trial design, choice of end points and adequate patient characterization is important when evaluating new therapies.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

References

  1. Tan, W. S. et al. Adjuvant intravesical chemohyperthermia versus passive chemotherapy in patients with intermediate-risk non–muscle-invasive bladder cancer (HIVEC-II): a phase 2, open-label, randomised controlled trial. Eur. Urol. 83, 497–504 (2023).

    Article  CAS  PubMed  Google Scholar 

  2. Angulo, J. C. et al. Hyperthermic mitomycin C in intermediate-risk non–muscle-invasive bladder cancer: results of the HIVEC-1 trial. Eur. Urol. Oncol. 6, 58–66 (2023).

    Article  PubMed  Google Scholar 

  3. Tan, W. S. et al. Intermediate-risk non–muscle-invasive bladder cancer: updated consensus definition and management recommendations from the International Bladder Cancer Group. Eur. Urol. Oncol. https://doi.org/10.1016/j.euo.2022.05.005 (2022).

  4. Kamat, A. M. et al. Definitions, end points, and clinical trial designs for non-muscle-invasive bladder cancer: recommendations from the International Bladder Cancer Group. J. Clin. Oncol. 34, 1935–1944 (2016).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Lindgren, M. S. et al. DaBlaCa-13 study: oncological outcome of short-term, intensive chemoresection with mitomycin in nonmuscle invasive bladder cancer: primary outcome of a randomized controlled trial. J. Clin. Oncol. 41, 206–211 (2023).

    Article  CAS  PubMed  Google Scholar 

  6. Kelly, J. D. et al. BOXIT—a randomised phase III placebo-controlled trial evaluating the addition of celecoxib to standard treatment of transitional cell carcinoma of the bladder (CRUK/07/004). Eur. Urol. 75, 593–601 (2019).

    Article  CAS  PubMed  Google Scholar 

  7. US Department of Health and Human Services, US Food and Drug Administration, Center for Drug Evaluation and Research (CDER) and Center for Biologics Evaluation and Research (CBER). BCG-Unresponsive Nonmuscle Invasive Bladder Cancer: Developing Drugs and Biologics for Treatment. Guidance for Industry (FDA, 2018).

  8. Balar, A. V. et al. Pembrolizumab monotherapy for the treatment of high-risk non-muscle-invasive bladder cancer unresponsive to BCG (KEYNOTE-057): an open-label, single-arm, multicentre, phase 2 study. Lancet Oncol. 22, 919–930 (2021).

    Article  CAS  PubMed  Google Scholar 

  9. Boorjian, S. A. et al. Intravesical nadofaragene firadenovec gene therapy for BCG-unresponsive non-muscle-invasive bladder cancer: a single-arm, open-label, repeat-dose clinical trial. Lancet Oncol. 22, 107–117 (2021).

    Article  CAS  PubMed  Google Scholar 

  10. Tan, W. S. et al. Radiofrequency-induced thermo-chemotherapy effect versus a second course of Bacillus Calmette-Guérin or institutional standard in patients with recurrence of non–muscle-invasive bladder cancer following induction or maintenance Bacillus Calmette-Guérin therapy (HYMN): a phase III, open-label, randomised controlled trial. Eur. Urol. 75, 63–71 (2019).

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Wei Shen Tan.

Ethics declarations

Competing interests

W.S.T. was a consultant to Combat Medical and research fellow and co-principal investigator for the HYMN and HIVEC-II trials. E.H. reports grants paid to their institution from Merck Sharpe & Dohme, Bayer, AstraZeneca, Accuray, Aventis Pharma, Varian Medical Systems, Janssen-Cilag and Roche. A.M.K. received grants from Adolor, BMS, FKD Industries, Heat Biologics, Janssen, Merck, Photocure, Seattle Genetics, Taris and SWOG; is on the board of and receives consulting fees from Asieris, Astellas, Biological Dynamics, BMS, CG Oncology, H3 Biomedicine, Eisai, Engene, FerGene, Imagin Medical, Incyte DSMB, Janssen, Medac, Merck, Photocure, ProTara, Roche, Seattle Genetics, Sessen Bio, Theralase, TMC Innovation, US Biotest and Urogen; has a joint patent for CyPRIT (Cytokine Predictors of Response to Intravesical Therapy) with UT MD Anderson Cancer Center; and is the President of the International Bladder Cancer Group (IBCG). J.D.K. was chief investigator for the HYMN and HIVEC-II trials, consultant to Combat Medical and is funded by the University College London Hospitals Biomedical Research Centre, Intuitive Surgical and The Urology Foundation.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tan, W.S., Hall, E., Kamat, A.M. et al. Clinical trial design for non-muscle-invasive bladder cancer. Nat Rev Urol 20, 575–576 (2023). https://doi.org/10.1038/s41585-023-00789-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41585-023-00789-0

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing