What is Intravesical Therapy for Bladder Cancer?

August 27, 2026

Intravesical therapy for bladder cancer is a treatment that places medicine directly into the bladder through a catheter. It is most commonly used for non-muscle invasive bladder cancer (NMIBC) after tumor removal surgery (TURBT). Because the medicine stays inside the bladder, it can target cancer cells while limiting effects on the rest of the body. Common intravesical treatments include BCG immunotherapy, Adstiladrin®, Anktiva®, gemcitabine, mitomycin C, and combination therapies. 

What is intravesical therapy?

Intravesical therapy is a bladder cancer treatment that delivers medicine directly into the bladder via a thin tube called a catheter.  

It is most often used for: 

• Carcinoma in situ (CIS) 

• Intermediate-risk NMIBC 

• High-risk NMIBC 

• Recurrent bladder cancer after TURBT 

Watch: What is intravesical therapy?

What are the benefits of intravesical therapy? 

• Targets cancer cells directly inside the bladder 

• Reduces exposure to the rest of the body 

• Often causes fewer systemic side effects than intravenous chemotherapy 

• Can help lower the risk of the cancer coming back 

Who Is a Candidate for Intravesical Therapy? 

Intravesical therapy is typically recommended for people with non-muscle invasive bladder cancer that has not spread into the bladder muscle. 

Your doctor may recommend intravesical treatment if: 

• You have high-grade Ta, T1, or CIS bladder cancer. 

• Your cancer has returned after a TURBT. 

• You have intermediate- or high-risk NMIBC. 

• You need treatment to reduce the risk of the cancer coming back. 

Intravesical therapy is generally not used for muscle-invasive or metastatic bladder cancer because the medicine only treats the inside lining of the bladder. 

What Types of Intravesical Therapy Are Available? 

Intravesical therapies include immunotherapy, gene therapy and chemotherapy options.

BCG (Bacille Calmette-Guerin) Immunotherapy

BCG, or Bacille Calmette-Guérin, is an intravesical immunotherapy commonly used for high-risk non-muscle-invasive bladder cancer, including carcinoma in situ (CIS). It is placed directly into the bladder through a catheter and stimulates the immune system to attack cancer cells. Learn more about BCG treatment for bladder cancer, including treatment schedules, side effects and what to expect.

Newer options for certain patients whose cancer does not respond to BCG include Adstiladrin and Anktiva.

Adstiladrin® (Nadofaragene Firadenovec-vncg)

Adstiladrin is a gene therapy approved for patients with carcinoma in situ (CIS) who did not respond to BCG. It works by delivering the interferon alpha-2b gene into bladder cancer cells, which activates immune cells to target and kill cancer cells. 

Potential Benefits 

• Administered once every three months 

• May delay or avoid bladder removal in some patients 

• Targets cancer locally within the bladder 

Anktiva (Nogapendekin Alfa Inbakicept-pmln)

Anktiva® is an immunotherapy that enhances the immune response against bladder cancer by activating a protein called interleukin-15. It’s approved for patients with CIS who didn’t respond to BCG and is used together with BCG to boost its effectiveness. Delivered through a catheter into the bladder, Anktiva® can help reduce cancer in some patients, though results vary.  

Common Side Effects  

• Bladder irritation 

BCG, Adstiladrin®, and Anktiva® all work to stimulate the immune system to fight cancer cells in the bladder. This is different from other immunotherapies like checkpoint inhibitors, which block pathways cancer cells use to hide from the immune system.  

Intravesical chemotherapy

Chemotherapy (chemo) drugs can be put right into the bladder through a catheter. These drugs can kill actively growing cancer cells. Intravesical chemotherapy is most often used when intravesical immunotherapy with BCG doesn’t work. Giving chemo right into the bladder instead of injecting it into the bloodstream means these medicines that can kill cancer usually do not reach and effect other parts of the body. This helps people avoid many of the side common effects that a person who receives systemic chemotherapy might experience.  

What chemotherapy can be put directly into the bladder? 

Gemcitabine

Gemcitabine is a medicine that can help stop bladder tumors from coming back after surgery (TURBT).  

Benefits include: 

• usually well tolerated 

• most people don’t have serious side effects  

• Taking another medicine known as oral alkalization can help prevent side effects like nausea, vomiting, hair loss, or low blood counts. 

Side effects 

needing to urinate more often 

INLEXZO™

INLEXZO is a small device that a doctor places inside your bladder using a catheter. The device slowly releases a chemotherapy medicine called gemcitabine over about three  weeks. The medicine stays in your bladder longer to fight the cancer cells, while lowering the amount that goes to the rest of your body.  

INLEXZO is an option for some people whose cancer did not get better with BCG and who cannot, or choose not to, have surgery to remove the bladder. 

Mitomycin C

Mitomycin C is another medicine used after TURBT that can help reduce the chance of bladder tumors returning by up to 50%.  

Benefit: Mitomycin C is that it does not easily enter the bloodstream, which presents fewer issues than chemotherapy given through an IV.  

Some side effects can include: 

• pain when urinating  

• irritation of the bladder lining, which can feel like a urinary tract infection 

These side effects are temporary and will go away once the treatment stops. 

ZUSDURI™

ZUSDURI™ is a treatment for people with low-grade, intermediate-risk NMIBC that has come back but has not spread into the bladder wall.  

Once inside, it warms to body temperature and becomes a gel.  

Key Features 

• The medicine goes into the bladder as a liquid through a thin tube (catheter). 

• Warms to body temperature and becomes a gel 

• The gel slowly releases the cancer medicine (mitomycin) for about five hours, sometimes up to 24 hours, and then leaves the body when you urinate. 

• Weekly treatment for six weeks 

• Administered in a doctor’s office 

• No surgery or anesthesia required 

Common side effects   

• pain or burning when you pee 

• bladder infection 

• blood in the urine 

• changes in blood tests 

It is very important to follow your doctor’s instructions and avoid having urine touch your skin for at least 24 hours.  

Gemcitabine with Docetaxel

Gemcitabine with Docetaxel 

Gemcitabine with Docetaxel (Gem/Doce) treatment combines gemcitabine with another medicine called docetaxel, and both are given directly into the bladder in a series of visits to the doctor’s office after TURBT.  

During the visit, one drug is given, drained out of the bladder, and then the second drug is administered. The side effects are similar to those of gemcitabine alone. 

ZUSDURI is a treatment for people with low-grade, intermediate-risk bladder cancer that has come back but has not spread into the bladder wall. The medicine goes into the bladder as a liquid through a thin tube (catheter). Once inside, it warms to body temperature and becomes a gel. The gel slowly releases the cancer medicine (mitomycin) for about 5 hours, sometimes up to 24 hours, and then leaves the body when you urinate. This chemotherapy is put into the bladder once a week for 6 weeks for patients with low grade recurrent NMIBC. You go home the same day after treatment. It is done in an office setting without any surgery or anesthesia. It is very important to follow your doctor’s instructions and avoid having urine touching your skin for at least 24 hours. Common side effects include pain or burning when you pee, bladder infection, blood in the urine, and changes in blood tests.

Valrubicin

Valrubicin may also be given to some patients, especially if their carcinoma in situ (CIS) bladder cancer has not responded to BCG treatment. 

It is usually given to people who cannot have surgery right away to remove the bladder. 

Questions to ask your doctor about intravesical therapy

1. Which intravesical therapy do you recommend for my bladder cancer? 

1. What are the chances it will prevent recurrence? 

2. How long will treatment last? 

3. What side effects should I expect? 

4. What are my options if this treatment does not work? 

5. Will I need ongoing surveillance after treatment? 

Frequently asked questions about intravesical therapy

Is intravesical therapy chemotherapy? 

Not always. Intravesical therapy includes both chemotherapy and immunotherapy treatments. BCG, Anktiva®, and Adstiladrin® are immunotherapies, while gemcitabine and mitomycin C are chemotherapy drugs. 

Is BCG the same as chemotherapy? 

No. BCG is an immunotherapy that activates the body’s immune system to attack bladder cancer cells. 

How long does intravesical therapy stay in the bladder? 

Most treatments stay in the bladder for one to two hours before being emptied. Some newer treatments, such as INLEXZO™ and ZUSDURI™, stay active in the bladder much longer. 

What is the success rate of BCG therapy? 

BCG is considered one of the most effective treatments for high-risk NMIBC and significantly reduces recurrence and progression risk in many patients. 

Can intravesical therapy cure bladder cancer? 

For some patients with NMIBC, intravesical therapy can eliminate visible cancer and reduce the risk that it will come back. Continued surveillance remains important because bladder cancer can return.