J Korean Med Assoc.  2025 Apr;68(4):228-234. 10.5124/jkma.25.0042.

Intravesical therapy for bladder cancer: a narrative review

• Oh JJ
• Hong SK

• KMID: 2568119
• DOI: http://doi.org/10.5124/jkma.25.0042

Abstract

Purpose
Intravesical therapy is crucial in treating non-muscle invasive bladder cancer (NMIBC), aiming to prevent recurrence and progression following transurethral resection of bladder tumor. This review provides an overview of intravesical therapies, including Bacillus Calmette-Guérin (BCG), intravesical chemotherapy, and emerging treatment modalities.
Current Concepts
BCG therapy remains the gold standard for high-risk NMIBC, significantly reducing recurrence and progression rates. However, managing BCG-unresponsive disease remains challenging and necessitates alternative treatment approaches. Intravesical chemotherapy, such as mitomycin C and gemcitabine, is frequently employed for intermediate-to-high-risk NMIBC and as a second-line therapy after BCG failure. Recent advancements have introduced novel intravesical approaches aiming to overcome BCG resistance and enhance treatment efficacy. Innovative methods, including viral gene therapy and nogapendekin alfa-inbakicept, are being studied for their potential to improve tumor eradication while minimizing toxicity. These strategies aim to increase immune activation, increase drug penetration, and reduce recurrence rates in NMIBC.
Discussion and Conclusion
Despite advances, optimizing intravesical treatment selection remains challenging. While BCG therapy is effective, resistance and side effects limit its utility, necessitating alternative therapies. Intravesical chemotherapy is beneficial but suboptimal for high-risk NMIBC. Emerging therapies offer promising solutions for BCG-unresponsive NMIBC. Future research should focus on biomarker-driven treatment and combination strategies to enhance clinical outcomes. As new treatments emerge, intravesical therapy will continue to play a pivotal role in managing NMIBC.

Keyword

Non-muscle-invasive bladder neoplasm; Administration, intravesical; BCG vaccine; Drug therapy; 비근육침윤성 방광암; 방광 내 주입 요법; BCG 치료; 약물치료