Novel intravesical therapeutics in the treatment of non-muscle invasive bladder cancer: horizon scanning

Kelly Ward, Mark Kitchen, Suresh-Jay Mathias, Farhat Khanim, Rik Bryan

Research output: Contribution to journalReview articlepeer-review

112 Downloads (Pure)


Introduction: Non-muscle-invasive bladder cancer (NMIBC) is a common and heterogeneous disease; many patients develop recurrent or progress to muscle-invasive disease. Intravesical drug therapy is a pillar in the current management of NMIBC; notwithstanding, Mitomycin C (MMC) and Bacillus Calmette-Guérin (BCG) have numerous limitations including international supply issues, and local and systemic toxicity. Here we review novel intravesical therapeutic options and drug delivery devices with potential for clinical use in the treatment of NMIBC.

Methods: PubMed, and Cochrane Library searches were undertaken. Systematic reviews, meta-analyses, randomised controlled trials, single-arm clinical trials and national/international conference proceedings were included.

Results: Novel intravesical drugs, including chemotherapeutic agents, immune checkpoint inhibitors, monoclonal antibodies and gene therapies, have demonstrated varying efficacy in the treatment of NMIBC. Current evidence for the majority of treatments is mostly limited to single-arm trials in patients with recurrent NMIBC. Various novel methods of drug delivery have also been investigated, with encouraging preliminary results supporting the intravesical delivery of hyperthermic MMC and MMC hydrogel formulations.

Conclusions: Novel therapeutic agents and drug delivery systems will be important in the future intravesical management of NMIBC. As our understanding of the molecular diversity of NMIBC develops, molecular subtyping will become fundamental in the personalisation of intravesical treatments. Further randomised studies are urgently required to investigate the efficacy of novel intravesical treatments and novel regimens, in comparison to current standards-of-care, particularly in the context of international BCG shortages.
Original languageEnglish
Article number912438
Number of pages14
JournalFrontiers in Surgery
Publication statusPublished - 26 Jul 2022

Bibliographical note

Funding Information:
RT Bryan contributes to advisory boards for Nonacus Limited and undertakes research funded by Janssen; he has previously conducted research funded by UroGen Pharma and QED Therapeutics. All other authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Funding Information:
We would like to thank the Metchley Park Medical Society for funding KW's Research Fellowship at the Bladder Cancer Research Centre, University of Birmingham, UK.

Publisher Copyright:
2022 Ward, Kitchen, Mathias, Khanim and Bryan.


  • electromotive therapy
  • gemcitabine
  • gene therapy
  • hydrogels
  • immune checkpoint inhibitors
  • intravesical
  • monoclonal antibodies
  • non-muscle invasive bladder cancer

ASJC Scopus subject areas

  • Surgery


Dive into the research topics of 'Novel intravesical therapeutics in the treatment of non-muscle invasive bladder cancer: horizon scanning'. Together they form a unique fingerprint.

Cite this