Combination Intravesical Chemotherapy for Non–muscle-invasive Bladder Cancer

Bacillus Calmette-Guérin (BCG) replaced early intravesical chemotherapeutic agents as the standard of care for non–muscle-invasive bladder cancer (NMIBC) with its US Food and Drug Administration approval in 1990. Multiple studies have proven the superiority of BCG to surgery alone, and to older single-agent intravesical chemotherapy regimens. However, new multiagent intravesical chemotherapy regimens have been developed and tested in recent years. Such regimens offer the possibility of better efficacy and/or tolerability compared to BCG. However, high-quality data comparing such regimens to BCG remain scant. We briefly review the literature regarding combination intravesical chemotherapy for NMIBC. Combination intravesical chemotherapy is an understudied approach for non–muscle-invasive bladder cancer. Some treatment protocols have demonstrated promising results, but further follow-up and comparative analyses are needed.