NMIBC immunotherapy treatment algorithm
| NMIBC risk category | Management | ||
| Low-risk | BCG not recommended | ||
| Intermediate-risk (BCG available) | BCG†-induction and 1-year maintenance | ||
| Intermediate-risk (BCG unavailable) | Intravesical chemotherapy | If recurrence occurs | BCG† |
| High-risk* | BCG† induction and 3 years maintenance | If BCG-unresponsive high-risk CIS NMIBC with or without papillary tumors | Pembrolizumab |
Individual rows represent treatment decision options that can be followed from left to right horizontally in adjacent columns.
*Including NMIBC high-risk cases with CIS or papillary tumors.
†BCG should not be administered to patients with active infection or gross hematuria, but BCG may be administered to patients experiencing asymptomatic bacteriuria. Best supportive measures should be employed to ensure that patients receive a full, adequate course of BCG.
BCG, Bacillus Calmette-Guérin; CIS, carcinoma in situ; NMIBC, non-muscle-invasive bladder cancer.