Oncobiotics in urinary bladder cancer. A narrative review of living cancer therapeutics (LCTs)

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Urinary bladder cancer (UBC) has high recurrence rates and limited treatment options for patients who do not respond to standard therapies.
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Living Cancer Therapeutics (LCTs) include bacteria-, virus-, and microbiome-based oncobiotics that may address limitations of conventional cancer therapies.
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Five mechanisms of action for oncobiotics include tumor destruction, immune modulation, engineered drug delivery, oncolytic virotherapy, and microbiome influence.
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Clinical translation has advanced for immune-mediated approaches like Bacillus Calmette–Guérin (BCG), but evidence is limited by small studies and short follow-up.
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Challenges for LCTs in UBC include delivery efficiency, biological barriers, immune neutralization, and the need for more extensive clinical data.

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