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Keywords:

  • bladder cancer;
  • intravesical therapy;
  • non-muscle-invasive bladder cancer (NMIBC);
  • bacillus Calmette-Guérin;
  • mitomycin;
  • BCG failure

Abstract

What's known on the subject? and What does the study add?

Intravesical therapy is a well-established treatment option for non-muscle invasive bladder cancer (NMIBC). Whilst therapeutic options are well defined in national and international guidelines there is not always consensus on the best treatment regime. The choice of intravesical agent, schedule and duration of treatment remains contentious.

We provide a contemporary review of the intravesical agents that are currently used in the management of NMIBC and examine the indications and limitations of their use. Our study reiterates the current evidence base which supports:

  • A single dose of intravesical chemotherapy ≤24 h (ideally ≤6 h) after new bladder tumour resection.
  • For patients at intermediate- or high-risk of progression, intravesical BCG with a maintenance regime is superior to induction-only BCG therapy and intravesical chemotherapy.
  • Whilst evidence for thermo-chemotherapy, electromotive drug administration and gemcitabine continues to grow, timely cystectomy is preferable in cases of BCG failure.
  • Intravesical therapy is a well-established treatment option for non-muscle-invasive bladder cancer (NMIBC).
  • Choosing the appropriate intravesical agent, schedule and duration of treatment has long been an area of debate.
  • We review the intravesical agents that are currently used in the management of NMIBC and examine the indications and limitations of their use.
  • Given the relative high rates of toxicity, failure and non-completion of traditional treatments we also examine some of the newer treatment options available.