Table 2

NMIBC immunotherapy treatment algorithm

NMIBC risk categoryManagement
Low-riskBCG not recommended
Intermediate-risk (BCG available)BCG†-induction and 1-year maintenance
Intermediate-risk (BCG unavailable)Intravesical chemotherapyIf recurrence occursBCG†
High-risk*BCG† induction and 3 years maintenanceIf BCG-unresponsive high-risk CIS NMIBC with or without papillary tumorsPembrolizumab
  • 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.