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This text discusses the advancements in bladder preservation options for bladder cancer, particularly for patients who are unable or unwilling to undergo radical cystectomy. The use of immunotherapy and antibody drug conjugates has improved the durability of responses and survival rates. The text emphasizes the importance of a multidisciplinary approach and shared decision-making based on patient preferences and values. It also highlights the need for further research and understanding of the trade-offs associated with different treatment options. The authors express optimism for advancements in therapeutics and patient perspectives in the future. [Extracted from the article]

Objectives: To test if intravesical instillation of both an anti‐programmed cell death protein 1 (PD‐1) inhibitor and an oncolytic reovirus would demonstrate a greater effect than either treatment alone, as non‐muscle‐invasive bladder cancer that is refractory to intravesical bacillus Calmette–Guérin can be treated by systemic anti‐PD‐1 immunotherapy and we previously demonstrated improved overall survival (OS) with six once‐weekly instillations of intravesical anti‐PD‐1 in a murine model. Materials and Methods: Using an orthotopic syngeneic C3H murine model of MBT2 urothelial bladder cancer, groups of 10 mice were compared between no treatment, intravesical anti‐PD‐1, intravesical oncolytic reovirus, or intravesical reovirus + anti‐PD‐1. A single intravesical treatment session was given. The primary outcome was OS, and the secondary outcomes included long‐term immunity and tumour–immune profile. Results: With a median follow‐up of 9 months, all mice that received no treatment died with a median survival of 41 days, while the comparison median OS was not reached for reovirus (hazard ratio [HR] 14.4, 95% confidence interval [CI] 3.9–32.6; P < 0.001), anti‐PD‐1 (HR 28.4, 95% CI 7.0–115.9; P < 0.001), and reovirus + anti‐PD‐1 (HR 28.4, 95% CI 7.0–115.9; P < 0.001). Monotherapy with anti‐PD‐1 or reovirus demonstrated no significant differences in survival (P = 0.067). Mass cytometry showed that reovirus + anti‐PD‐1 treatment enriched monocytes and decreased myeloid‐derived suppressor cells, generating an immuno‐responsive tumour microenvironment. Depletion of CD8+ T cells eliminated the survival advantage provided by the intravesical treatment. Conclusions: Treatment of murine orthotopic bladder tumours with a single instillation of intravesical reovirus, anti‐PD‐1 antibody, or the combination confers superior survival compared to controls. Tumour–immune microenvironment differences indicated myeloid‐derived suppressor cells and CD8+ T cells mediate the treatment response. [ABSTRACT FROM AUTHOR]

Intravesical therapy for nonmuscle invasive bladder cancer decreases recurrence and progression but carries a high risk of side effects, which limit patient adherence. Appropriate management of the toxicities from intravesical therapy requires consideration of the agent used, the side effects experienced, and the timing of those side effects. Management strategies for intravesical toxicities ideally improve patient tolerance without sacrificing oncologic outcomes. This review aims to provide a comprehensive overview of the available evidence regarding the side effects of intravesical therapies for nonmuscle invasive bladder cancer and to propose practical strategies for toxicity management. [ABSTRACT FROM AUTHOR]