{"entity":{"id":"bcg-and-intravesical-therapy","kind":"technology","name":"Intravesical therapy (BCG, chemotherapy, devices, gene and viral therapy)","aka":[],"tldr":"Treating early bladder cancer by putting the drug straight into the bladder through a catheter, so the whole body is spared.","summary":"BCG remains the backbone for high-risk NMIBC; intravesical gemcitabine or mitomycin for intermediate risk. The BCG-unresponsive space now has four approved options: pembrolizumab (systemic), nadofaragene firadenovec (2022), N-803 + BCG (2024), and the gemcitabine-eluting TAR-200 device (2025), with cretostimogene filing in 2026. Durvalumab + BCG (2026) is the first systemic immunotherapy added to BCG-naive treatment.","status":"standard-of-care","asOf":"2026-09-07","links":[{"label":"EAU guidelines: non-muscle-invasive bladder cancer","url":"https://uroweb.org/guidelines/non-muscle-invasive-bladder-cancer"},{"label":"NCI PDQ: bladder cancer treatment","url":"https://www.cancer.gov/types/bladder/patient/bladder-treatment-pdq"}],"tags":[],"related":[],"cancers":["urothelial","non-muscle-invasive-bladder-cancer"],"sections":["immunotherapy","devices"],"technologies":[],"targets":[],"drugs":["bcg-intravesical","tar-200","cretostimogene","nogapendekin-alfa","nadofaragene-firadenovec"],"companies":[],"institutions":[],"pathways":[],"terms":["nmibc-vs-mibc","bcg-unresponsive"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"Direct urothelial exposure to immunostimulants, cytotoxics, viruses, or gene vectors; dwell time and device release kinetics determine efficacy.","strengths":["Minimal systemic toxicity","Bladder preservation","Repeatable in clinic"],"limitations":["BCG shortages","Progression to muscle invasion still occurs","Frequent cystoscopic surveillance"]},"route":"/technologies/bcg-and-intravesical-therapy/","neighbours":{"cancer":[{"id":"urothelial","kind":"cancer","name":"Bladder & urothelial cancer","route":"/cancers/urothelial/"},{"id":"non-muscle-invasive-bladder-cancer","kind":"cancer","name":"Non-muscle-invasive bladder cancer","route":"/cancers/non-muscle-invasive-bladder-cancer/"}],"section":[{"id":"devices","kind":"section","name":"Devices & Physical Therapies","route":"/fronts/devices/"},{"id":"immunotherapy","kind":"section","name":"Immunotherapy","route":"/fronts/immunotherapy/"}],"drug":[{"id":"cretostimogene","kind":"drug","name":"Cretostimogene grenadenorepvec","route":"/drugs/cretostimogene/"},{"id":"gemcitabine","kind":"drug","name":"Gemcitabine","route":"/drugs/gemcitabine/"},{"id":"tar-200","kind":"drug","name":"Gemcitabine intravesical system (TAR-200)","route":"/drugs/tar-200/"},{"id":"bcg-intravesical","kind":"drug","name":"Intravesical BCG","route":"/drugs/bcg-intravesical/"},{"id":"mitomycin","kind":"drug","name":"Mitomycin C","route":"/drugs/mitomycin/"},{"id":"nadofaragene-firadenovec","kind":"drug","name":"Nadofaragene firadenovec","route":"/drugs/nadofaragene-firadenovec/"},{"id":"nogapendekin-alfa","kind":"drug","name":"Nogapendekin alfa inbakicept","route":"/drugs/nogapendekin-alfa/"},{"id":"thiotepa","kind":"drug","name":"Thiotepa","route":"/drugs/thiotepa/"},{"id":"valrubicin","kind":"drug","name":"Valrubicin","route":"/drugs/valrubicin/"}],"term":[{"id":"bcg-unresponsive","kind":"term","name":"BCG-unresponsive","route":"/terms/bcg-unresponsive/"},{"id":"nmibc-vs-mibc","kind":"term","name":"Non-muscle-invasive vs muscle-invasive bladder cancer (NMIBC / MIBC)","route":"/terms/nmibc-vs-mibc/"}],"trial":[{"id":"nct06211764","kind":"trial","name":"A Study of TAR-200 Versus Intravesical Chemotherapy in Participants With Recurrent High-Risk Non-Muscle-Invasive Bladder Cancer (HR-NMIBC) After Bacillus Calmette-Guérin (BCG)","route":"/trials/nct06211764/"},{"id":"nct06545955","kind":"trial","name":"A Trial to Evaluate Intravesical Nadofaragene Firadenovec Alone or in Combination With Chemotherapy or Immunotherapy in Participants With High-grade BCG Unresponsive Non-muscle Invasive Bladder Cancer","route":"/trials/nct06545955/"},{"id":"sunrise-1","kind":"trial","name":"SunRISe-1","route":"/trials/sunrise-1/"},{"id":"nct06510374","kind":"trial","name":"Trial of Nadofaragene Firadenovec vs. Observation in Participants With Intermediate Risk Non-Muscle Invasive Bladder Cancer","route":"/trials/nct06510374/"}],"technology":[{"id":"trained-innate-immunity","kind":"technology","name":"Trained innate immunity","route":"/technologies/trained-innate-immunity/"}],"idea":[{"id":"idea-bio2-engineered-bacteria-payloads","kind":"idea","name":"Engineered bacteria that live in tumours and manufacture drugs there","route":"/ideas/idea-bio2-engineered-bacteria-payloads/"},{"id":"idea-bio2-trained-immunity-priming","kind":"idea","name":"Train the bone marrow to make better anti-tumour immune cells","route":"/ideas/idea-bio2-trained-immunity-priming/"}],"pathway":[{"id":"myeloid-suppression-axis","kind":"pathway","name":"Myeloid suppression: TAMs, MDSCs & don't-eat-me signals","route":"/pathways/myeloid-suppression-axis/"}],"roadmap":[{"id":"devices-roadmap","kind":"roadmap","name":"Devices and physical therapies roadmap: heat and light → electric fields and focused sound → drug-releasing implants","route":"/roadmaps/devices-roadmap/"}],"company":[{"id":"endo","kind":"company","name":"Endo (now Keenova Therapeutics and Par Health)","route":"/companies/endo/"}]}}