The Role of New Experimental Conservative Therapies for High Risk Non-Muscle Invasive Bladder Cancer: Could We Trust Them?

Despite adjuvant intravesical treatments, up to 40–50% of high-risk non-muscle invasive bladder cancer (NMIBC) patients will experience recurrence. The current evidence, due to the very aggressive behaviour of the disease, strongly recommends radical surgery for NMIBC patients failing intravesical immunotherapy (Bacillus Calmette-Guerin). However, on the other hand, radical surgery may sometimes represent an over-treatment, especially for those patients with non-high-grade recurrence. Moreover, some patients could be considered unfit for surgery due to the high comorbidity rates, as frequently observed in old patients. Therefore, the development of new adjuvant therapies, or at least the improvement of the existing ones is urgently needed. In the last years, several new device-assisted therapies have been developed with the aim to improve the effectiveness of intravesical chemotherapy by increasing its penetration into the bladder wall. Electromotive Drug Administration (EMDA) and chemo-hyperthermia (CHT) are, to date, the most investigated. Reported results are promising and showed that conservative therapies for high-risk NMIBC (CHT and EMDA) could represent a feasible and safe treatment, even if, due to the low level of evidence and to the lack of high-quality trials, remain, to date, experimental.