Non-Muscle-Invasive Bladder Cancer: What’s New After
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May is Bladder Cancer Awareness Month. If you’ve been diagnosed with non-muscle-invasive bladder cancer (NMIBC), you’ve probably heard about intravesical BCG. For decades, BCG has been the most effective way to treat high-risk early bladder cancer and help people avoid major surgery. But BCG doesn’t work for everyone—and until recently, the next step often meant bladder removal.
Today, that picture is changing. At Fox Chase Cancer Center, we can offer several FDA-approved treatments for certain patients whose NMIBC doesn’t respond to BCG or returns after BCG. These options are helping more people control the cancer while preserving their bladder—and they’re also giving patients more time and more choices.
BCG basics: what it is and how it works
BCG (Bacillus Calmette-Guérin) is an immunotherapy that’s placed directly into the bladder through a small catheter. That’s why you’ll often hear the word “intravesical,” which simply means “inside the bladder.”
BCG doesn’t work like traditional chemotherapy. Instead, it “wakes up” your immune system in the bladder so your body can attack cancer cells. Many patients do very well with BCG, but some don’t respond, and for others the cancer can come back after treatment ends.
When BCG isn’t enough
If NMIBC doesn’t respond to BCG—or if it returns soon after—you may hear your doctor use the term “BCG-unresponsive.” In the past, the safest path for many of these patients was a cystectomy (surgery to remove the bladder). That surgery can be life-saving, and for some patients it’s still the right choice.
But now, we have more bladder-sparing treatments that can be a good fit for selected patients—especially those with carcinoma in situ (CIS). CIS is a flat, high-grade tumor on the bladder lining that can be harder to treat. If keeping your bladder is an important goal, we can talk through options beyond bladder removal.
New bladder-sparing options at Fox Chase
Think of these as part of the same “after-BCG” toolbox. Some are delivered directly into the bladder, and one is given by IV. The right approach depends on your exact bladder cancer status, your prior treatments, bladder function, and your goals.
These advances are changing how we treat NMIBC. Instead of jumping straight from BCG to bladder removal, many patients now have additional FDA-approved choices that may control the cancer while preserving quality of life—especially when care is guided by a team that treats bladder cancer every day.
Anktiva + BCG (immune boost inside the bladder). For some patients, pairing BCG with Anktiva can help the immune system mount a stronger attack against the cancer. This combination is designed for certain BCG-unresponsive cases and can be an option when we want to keep treatment localized to the bladder.
Adstiladrin (intravesical gene therapy). Adstiladrin is placed into the bladder through a catheter, similar to BCG. The therapy uses a genetically modified virus to help bladder cells produce a cancer-fighting protein that supports an immune response against tumor cells. The medication is given less often, every 3 months, compared to weekly with BCG, which some patients find easier to manage.
INLEXZO (gemcitabine intravesical system). INLEXZO is a novel medical device that delivers a well-known cancer medicine (gemcitabine) directly into the bladder. Compared to standard intravesical therapy where the medication is in contact with the bladder for only one hour, the device allows a slow release of the medication over 3 weeks, allowing for greater efficacy in the BCG-unresponsive setting.
Keytruda (pembrolizumab) — is an immunotherapy used primarily to treat patients’ metastatic disease and compared to most bladder medication for NMIBCA is given IV. Keytruda helps your immune system recognize and attack cancer cells and can be an option for patients who are not able to tolerate intravesical medication and are wanting to avoid an early cystectomy.
How we decide what’s right for you
At Fox Chase, your plan is built around you—not just your pathology report. We look at the type and grade of NMIBC, whether CIS is present, what treatments you’ve already had, and how your bladder is responding. Just as important, we talk through your priorities: preserving your bladder, minimizing side effects, and feeling confident about the next step.
This is where a multidisciplinary approach matters. Urologic oncology and medical oncology work together to match the right therapy to the right patient. We also partner closely with radiology and pathology, and we build a follow-up plan that keeps a close eye on the bladder over time.
Questions to ask at your next visit
What type of NMIBC do I have (including whether I have CIS)?
Did my cancer respond to BCG, if so for how long, and what does that mean for next steps?
Which bladder-sparing options do I qualify for—and what are the goals of each?
What are the most common side effects, and how do we manage them?
What does follow-up look like after treatment (cystoscopy schedule, imaging, labs)?
If bladder removal becomes necessary, when would we consider it—and why?
Get expert care for NMIBC at Fox Chase
If you’ve been treated with BCG and are looking for new options—or you want a second opinion—Fox Chase can help. We offer full-spectrum bladder cancer care, including advanced intravesical therapies, systemic immunotherapy when appropriate, and access to clinical trials.
Call 888-FOX-CHASE or request an appointment online to meet with our team and review your options.
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