Advances in recombinant Bacillus Calmette–Guérin therapy for bladder cancer from 2015 to 2024: Innovations and challenges

Background: Non-muscle invasive bladder cancer is commonly treated by Bacillus Calmette–Guérin (BCG) therapy, but its efficacy is limited. Research into recombinant BCG (rBCG) aims to enhance its effectiveness and minimize side effects through genetic modifications. Objective: This review explored advancements in rBCG therapy (2015 – 2024), focusing on genetic modifications designed to enhance cytokine production, introduce bacterial effectors, and boost immune responses. It also discusses future research on alternatives such as Mycobacterium smegmatis for safety concerns and integrating rBCG with other therapies to improve patient outcomes. Conclusion: While rBCG therapies offer promising potential, overcoming translational challenges entails interdisciplinary endeavor to address the issues of safety, cost, and accessibility, and ultimately maximize their benefits for bladder cancer patients.