卡介苗 (BCG) 疗法是治疗高危非肌层浸润性膀胱癌 (NMIBC) 的标准护理方法。如果对卡介苗没有反应且疾病持续存在严重程度，建议根据临床风险进行膀胱切除术。目前正在对卡介苗无反应的 NMIBC 进行随机研究，研究针对免疫和基于基因的分子靶点（例如 PD-(L)1 和 FGFR）的多种靶向治疗方法。此外，正在临床试验中研究滴注疗法的新应用形式，例如 TAR 装置与吉西他滨或厄达菲替尼的组合，以延长活性物质对尿路上皮的作用持续时间。因此，现在有许多进展可以使膀胱保留疗法具有可比较的生存数据，作为卡介苗的替代方案或在卡介苗失败的情况下成为可能。将来，有必要澄清如何使用分子标记来预测 BCG 反应，以及如何定义主要应接受 BCG 替代疗法的风险群体。© 2024。作者获得独家许可Springer Medizin Verlag GmbH，是 Springer Nature 的代表。

Bacillus Calmette-Guérin (BCG) therapy is the standard of care in the treatment of high-risk non-muscle invasive bladder cancer (NMIBC). In the absence of a response to BCG and persistent high-grade disease, cystectomy is recommended depending on the clinical risk. A variety of targeted therapy approaches, which aim at immune- and gene-based molecular targets, such as PD-(L)1 and FGFR, are currently being investigated in randomized studies for BCG-unresponsive NMIBC. Furthermore, novel forms of application for instillation therapy, such as the TAR device, in combination with gemcitabine or erdafitinib are being investigated in clinical trials in order to extend the duration of action of the active substance on the urothelium. Thus, there are now many developments that could make bladder-preserving therapy with comparable survival data possible as an alternative to BCG or in the event of BCG failure. In the future, it will be necessary to clarify how BCG response can be predicted by using molecular markers and how to define risk groups that should primarily be given an alternative therapy to BCG.© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.