Bladder cancer ranks as the 10th most commonly diagnosed cancer globally, affecting both men and women. Approximately 75% of patients are initially diagnosed with non-muscle invasive bladder cancer (NMIBC), which is confined to the mucosa. The standard treatment for NMIBC involves endoscopic and transurethral resection of the lesion, often followed by adjuvant intravesical chemo- or immunotherapy with Bacillus Calmette Guerin (BCG) for those at high risk of progression or recurrence. Despite these interventions, nearly 50% of patients progress to muscle-invasive disease within five years. This raises critical questions about the variability in patient responses to BCG therapy. The human body hosts trillions of microbes that play a crucial role in immunity, influencing both innate and adaptive immune responses. Recent studies have revealed a diverse urinary microbiome, challenging the long-held belief that urine is sterile. Techniques like 16S rRNA amplification and sequencing have identified various microbial species, including bacteria, fungi, archaea, and viruses. Dysbiosis in these microbial communities has been linked to disease. Additionally, the gut microbiome's influence on the immune system, particularly in cancer response, has been extensively studied. It has been shown to affect the response to immune checkpoint blockade in various cancers, suggesting that the tumor microenvironment is crucial in immunotherapy. This raises the possibility that the composition of urinary and gut microbiomes in NMIBC patients may influence their response to BCG therapy.

This Research Topic aims to investigate the role of gut and urinary microbiota in NMIBC patients undergoing adjuvant BCG therapy, focusing on both responders and non-responders. The primary objective is to understand whether specific microbial compositions can enhance or hinder the anti-tumor response during BCG treatment. By exploring this, the research seeks to answer critical questions about the potential influence of microbiota on therapy outcomes and to identify microbial markers that could predict patient responses. The research will involve experimental studies, including randomized and non-randomized trials, prospective studies, meta-analyses, and systematic reviews, to provide a comprehensive understanding of this complex interaction.

To gather further insights into the influence of microbiota on BCG therapy response in NMIBC patients, we welcome articles addressing, but not limited to, the following themes:
- Comparative analysis of urinary and gut microbiota in BCG responders versus non-responders.
- Mechanistic studies on how specific microbial species influence immune responses during BCG therapy.
- Identification of microbial biomarkers predictive of BCG therapy outcomes.
- The role of dysbiosis in therapy resistance or sensitivity.
- Interventions aimed at modulating microbiota to enhance BCG therapy efficacy.
- Longitudinal studies tracking microbiota changes during and after BCG treatment.

Please note: manuscripts consisting solely of bioinformatics or computational analysis of public genomic or transcriptomic databases which are not accompanied by validation (independent cohort or biological validation in vitro or in vivo) are out of scope for this section and will not be accepted as part of this Research Topic.

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