title: Intravesical therapy for bladder cancer.
abstract: BACKGROUND
  Transurethral resection of bladder tumor (TURBT) is the gold standard initial diagnostic intervention for bladder cancer and provides diagnostic, therapeutic and prognostic benefit in non-muscle-invasive bladder cancer (NMIBC). However, TURBT alone is inadequate for optimal management of NMIBC, as patients will experience recurrence or progression depending on tumor characteristics. Adjuvant intravesical therapy with either immunotherapy or chemotherapy has been shown to reduce recurrence and/or progression in appropriately selected patients through immunostimulation or direct cell ablation.
  
  
  METHODS
  This review will discuss risk stratification of patients with NMIBC and role of intravesical therapies in reducing recurrence and progression of disease in these patients. A Medline search was performed to identify the best available evidence available from various systematic reviews, meta-analyses, and clinical trials on various immunotherapy and chemotherapy agents. In addition, the main aspects of drug pharmacology (mechanism of action, dosing and administration) and side effects will be reviewed.
  
  
  CONCLUSIONS
  The selection of the appropriate intravesical agent for NMIBC is complex and is dependent on risk stratification and intravesical agent toxicity. Intravesical induction and maintenance immunotherapy with Bacillus Calmette-Guerin (BCG) is the preferred and most effective agent for patients with high-risk NMIBC (carcinoma in situ and high-grade disease) and reduces both recurrence and progression.
authors.affiliation: University of Chicago Medical Center, Department of Surgery, Section of Urology , 5841 S. Maryland Avenue, Chicago, IL 60637 , USA +1 773 702 5195 ; +1 773 702 1001 ; patelsg1@gmail.com.
authors.forename: Sanjay G
authors.initials: SG
authors.lastname: Patel
authors.forename: Andrew
authors.initials: A
authors.lastname: Cohen
authors.forename: Adam B
authors.initials: AB
authors.lastname: Weiner
authors.forename: Gary D
authors.initials: GD
authors.lastname: Steinberg
mesh_terms: D000283:Administration, Intravesical; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001500:BCG Vaccine / Q000627:therapeutic use; D059186:Chemoradiotherapy, Adjuvant; D018450:Disease Progression; D006801:Humans; D007167:Immunotherapy; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000276:immunology / Q000473:pathology / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents; D001500:BCG Vaccine
keywords: chemotherapy; immunotherapy; intravesical; therapeutics; urothelial neoplasms