Intravesical Chemotherapy and BCG for the Treatment of Bladder Cancer: Evidence and Opinion

ObjectivesReview the chemotherapeutic and immunotherapeutic options for post-resection intravesical treatment of low-risk, intermediate-risk, and high-risk non-muscle-invasive bladder cancer (bCA).Design, Setting, and ParticipantsThe authors conducted a review of the literature on chemotherapy and immunotherapy regimens used to reduce the risk of cancer recurrence and progression after transurethral resection of the bladder (TURB).Results and LimitationsThe choice of post-TURB regimen for intravesical treatment of non-muscle-invasive bCA depends on the risk category of the tumour: Chemotherapy is the treatment of choice for low-risk superficial bladder carcinoma; intermediate-risk disease can be treated with either chemotherapy or immunotherapy with bacillus Calmette-Guérin (BCG); and BCG is now the treatment of choice for high-risk tumours. In all cases, the overall aim of treatment is to prevent recurrence and delay disease progression. There is debate over the optimal treatment regimens, and the options may include sequential treatment with chemotherapy and BCG.ConclusionsIntravesical chemotherapy and BCG are both effective post-TURB treatments for non-muscle-invasive bCA, and the choice of regimen depends on the risk category of the tumour. There may also be a role for sequential instillations of chemotherapy and BCG.