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    Home > Active Ingredient News > Urinary System > CUA 2022| Professor Liu Zhuowei: Treatment strategies for high-risk NMIBC

    CUA 2022| Professor Liu Zhuowei: Treatment strategies for high-risk NMIBC

    • Last Update: 2023-02-03
    • Source: Internet
    • Author: User
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    The 29th National Urology Conference (CUA2022), hosted by the Chinese Medical Association and the Urology Branch of the Chinese Medical Association (CUA), organized by the Shanghai Medical Association, and co-organized by Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine, was held
    online on December 08-11, 2022 。 This year's annual meeting has set up 14 sub-venues such as tumor, stone, minimally invasive, urinary control, andrology, nursing, kidney transplantation, pediatric urology and laser, covering all aspects of the field of urology, comprehensively and deeply displaying and discussing the new progress and new technologies in the diagnosis and treatment of diseases in the industry, and will present a wonderful urology event
    for everyone.
    At the meeting, Professor Liu Zhuowei of the Cancer Center of Sun Yat-sen University shared with us the treatment strategies of high-risk NMIBC.

    Professor Liu Zhuowei

    Deputy Dean of Cancer Center of Sun Yat-sen University

    Professor, chief physician, doctoral supervisor

    China Urological Oncology Outstanding Youth Award

    "Outstanding Young Medical Talents" and "Yangcheng Good Doctor" in Guangdong Province

    Vice Chairman of the Multidisciplinary Diagnosis and Treatment Committee of Cancer of the Chinese Anti-Cancer Association

    Member of the Clinical Research Committee of the Asian Society of Urological Robotics (ARUS).

    Member of the Standing Committee of the CSCO Urothelial Carcinoma Committee

    Member of the Standing Committee of the Urogenital Cancer Committee of the Chinese Anti-Cancer Association

    Deputy leader of the Early Diagnosis and Early Treatment Collaborative Group of the Science Popularization Committee of the Chinese Anti-Cancer Association

    Vice Chairman of Urology Branch of Guangdong Medical Association

    Chairman-elect of the Genitourinary Oncology Professional Committee of Guangdong Anti-Cancer Association

    Director of Guangdong Medical Doctor Association

    Vice President of Guangdong Clinical Medical Association

    Vice President of Guangdong Health Management Association

    Problems and dilemmas in BCG treatment

    Domestic and foreign guidelines classify NMIBC into low-risk, intermediate-risk, high-risk or very high-risk groups, and the latest European guidelines also include risk factors
    such as age, whether it is multiple, and tumor size.
    At present, BCG bladder instillation is the preferred treatment
    for high-risk NMIBC as consistently recommended by domestic and foreign guidelines.
    However, BCG is less accessible, and there are BCG shortages even abroad; and BCG is a live bacterium preparation with specific adverse reactions (cystitis, hematuria, etc.
    ); What's more, BCG treatment failure is common, with studies reporting a 5-year recurrence rate of 66%
    with BCG treatment.
    Many drawbacks have brought certain challenges
    to clinical work.

    Arterial chemotherapy

    The Cancer Center of Sun Yat-sen University used arterial chemotherapy to replace the BCG regimen and achieved certain curative effects
    Arterial chemotherapy is mainly used as gemcitabine + cisplatin (GC).

    The advantage of arterial chemotherapy is that the drug concentration in local tissues is higher, and due to the low concentration of drug in circulating blood, systemic toxic side effects are small, and patients tolerate it well

    From January 2000 to July 2015, Professor Liu Zhuowei's team treated 266 T1 patients (60 in the RC group, 63 in the GC group, and 143 in the conventional chemotherapy group), and all patients had positive events
    within 1 year of follow-up or within 1 year.
    Studies have shown that 83% of patients successfully conserve the bladder
    after adjuvant arterial chemotherapy with GC regimens.
    Compared with literature data from previous BCG perfusion therapy, adjuvant arterial chemotherapy with GC regimens is similar
    in terms of tumor recurrence, progression, and disease-specific death.
    The 3-year progression-free survival (PFS) and 3-year tumor-specific death (CSS) rates in this study were also comparable
    to other literature data related to intravenous chemotherapy.
    At the same time, arterial chemotherapy regimens have significantly less
    hematologic toxicity than intravenous chemotherapy regimens.

    Evaluation of the efficacy of arterial chemotherapy

    Traditional molecular typing is not suitable for NMIBC, so Professor Liu Zhuowei's team has explored methods to evaluate the efficacy of arterial chemotherapy in clinical practice
    The study found that stage T1 bladder cancer of the basal/squamous (BASQ) subtype benefited most significantly from arterial chemotherapy, while arterial chemotherapy did not significantly improve the efficacy
    of patients with Luminal A subtype.

    Subsequently, Professor Liu Zhuowei's team conducted a prospective study to compare the efficacy of T1 high-grade bladder cancer, arterial chemotherapy and BCG bladder instillation, with the primary endpoint of 2-year recurrence-free survival (RFS) and secondary endpoints of PFS, CSS, and bladder preservation rate
    The results showed that the efficacy of arterial chemotherapy in GC regimen was comparable to that reported in retrospective studies.
    The efficacy of domestic BCG bladder infusion is similar to that of international programs, and it is effective in preventing recurrence of T1 high-grade bladder cancer

    BCG bladder instillation therapy

    At the same time, Professor Liu Zhuowei's team also evaluated
    the efficacy of BCG bladder infusion therapy.
    A total of 326 patients received BCG perfusion therapy, and a total of 311 patients completed follow-up
    The results showed that the 1-year RFS rate was 82% and the 2-year RFS rate was 53%; The 1-year PFS rate was 96% and the 2-year PFS rate was 83%.

    The efficacy of domestic BCG is similar
    to that of foreign BCG.

    At the same time, Professor Liu Zhuowei's team summarized the molecular characteristics of BCG perfusion benefits through whole exome/transcriptome sequencing, immunohistochemistry and other methods, and the immune infiltration of BCG ineffective group was more significant, and multiple immunosuppressive markers were highly expressed.
    There were high-frequency mutations in STAG2 in the BCG effective group, and the DFS of the patients with the mutation showed a good trend (p=0.

    Treatment after BCG perfusion failure

    PD-1 monoclonal antibody has been used in the second-line treatment of metastatic urothelial carcinoma and has achieved efficacy
    In addition, for NMIBC patients with carcinoma in situ (CIS) who do not respond to BCG perfusion, the complete response (CR) rate of pembrolizumab monotherapy can reach 42% and be approved
    by the FDA.

    Radiation therapy is one of the conventional treatments for tumors, which can induce immunity and thus increase the effect of immunotherapy, so will radiation therapy and immune checkpoint inhibitors produce a 1+1>2 effect? Professor Liu Zhuowei's team carried out relevant research
    The study selected suitable patients to receive tislelizumab plus radiotherapy, and the primary endpoint was a 1-year DFS rate
    From August 2020 to August 2022, a total of 14 patients with bladder cancer were enrolled, with 8 courses of immunotherapy and a median radiotherapy dose of 60Gy/30F
    The results showed a 1-year DFS rate of 80.
    0% (95% CI 67.
    6%) and a 2-year DFS rate of 60.
    0% (95% CI 40.
    The overall safety profile of this protocol was good, and 2 patients had grade 3 treatment-related adverse events, and no grade 4 or above adverse events

    Radical surgery for bladder cancer

    Finally, radical bladder cancer surgery is a well-known and guideline recommended treatment
    for T1 grade NMIBC.
    According to data from the Cancer Center of Sun Yat-sen University, the 5-year survival rate of patients with T1 high-grade NMIBC after radical surgery for bladder cancer reached 91%.


    The Cancer Center of Sun Yat-sen University is establishing a T1G3 prognostic model based on CT image deep learning to better evaluate the prognosis
    of NMIBC patients.

    Editor: Rudolf Reviewed: RudolfExecution: Uni

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