Intravesical therapy for bladder cancer

Abstract

The majority of patients with urothelial carcinoma (UCa) present with non-muscle invasive (superficial) disease. Whilst some patients may be managed by endoscopic transurethral surgery of the bladder tumour (TURBT) alone, a significant proportion will recur, and some may progress to muscle invasive disease. As a consequence intravesical chemotherapy and immunotherapy are important adjuvant treatments in combination with a thorough and complete TURBT. current evidence underpinning the choice of intravesical treatment in various tumour risk groups is reviewed in this chapter, along with the treatment regimes and toxicity associated with the different treatments. Arguments for and against single-instillation chemotherapy are analysed. The relative merits of intravesical chemotherapy and Bacille Calmette-Guerin (BCG) treatment are discussed in terms of prevention of tumour recurrence, prevention of tumour progression, and toxicity. The question of whether maintenance BCG is necessary is also considered. Finally, the management of patients who have failed primary intravesical treatment is reviewed, and newer treatments that are being developed for this group of patients are discussed.