Evolving Treatment in Non-muscle-Invasive Bladder Cancer

Treatment for NMIBC is evolving and depends on many factors including cancer pathology, risk stratification, and patient’s medical comorbidities, among many other aspects. Historically, NMIBC has been treated with surgical resection and intravesical BCG. More recently, many other forms of intravesical therapy including non-BCG immunotherapy, chemotherapy, gene therapy, viral therapy, and others, have been studied to treat patients with NMIBC. Primary goals of these new bladder preserving therapies include preventing disease recurrence and disease progression while improving overall survival. This chapter begins with a short introduction into the disease process and then shifts focus to the many treatment options for NMIBC. We discuss surgical management, the role for BCG and other immunotherapy, use of chemotherapy and then go into detail about the newest treatment options and their relevant clinical trials.