With multiple FDA-approved therapies now available for BCG-unresponsive non–muscle invasive bladder cancer, this conversation explores how clinicians are finally moving beyond the era of limited salvage options. The discussion dives into real-world treatment selection between intravesical gene therapies, novel immunostimulatory agents, and off-label chemotherapy—balancing efficacy, toxicity, patient quality of life, and logistical realities like BCG shortages. Practical insights highlight when re-induction with BCG still makes sense, how bladder symptoms and patient goals shape therapy choice, and which high-risk features should prompt early cystectomy. Together, it offers a candid look at modern bladder-sparing decision-making in a rapidly evolving therapeutic landscape.
Contributors:
Dr. Suzanne Merrill is a urologic oncologist with Colorado Urology in Denver, Colorado.
Dr. Bogdana Schmidt, MD, MPH, is a urologic surgeon specializing in urologic oncology at the University of Utah in Salt Lake City, Utah.
Dr. Mark Tyson is a urologic oncologist and professor of urology with Mayo Clinic in Scottsdale, Arizona.
