Chemoresection in Non-Muscle Invasive Bladder Cancer

Non-muscle invasive bladder cancer (NMIBC) is the most common type of bladder cancer. It affects about 3 out of 4 people with the disease.¹

While people with NMIBC are likely to recover from the disease, there is a real chance it will return (recur). Depending on how much the cancer has grown, this type of cancer has a 30 to 80 percent recurrence rate. Because bladder cancer comes back so often and can be aggressive, tumors are hard to treat.¹

A non-surgical treatment approved in 2025 now gives some people with NMIBC another option.²

What is LG-IR-NMIBC?

One group that faces frequent recurrence is people with low-grade intermediate-risk NMIBC (LG-IR-NMIBC). Low-grade means the cancer cells look more like normal cells and tend to grow slowly. Intermediate-risk means the cancer came back within 1 year, there is more than 1 tumor, or a single tumor is larger than 3 centimeters.^3,4

Low-grade NMIBC comes back in nearly half of those who have it, but it rarely grows into the bladder muscle. Because of this, many people with LG-IR-NMIBC have needed surgery multiple times to remove new tumors.⁵

How does chemoresection for LG-IR-NMIBC work?

Chemoresection (or chemoablation) uses drugs to destroy tumors instead of removing them with surgery. In June 2025, the US Food and Drug Administration (FDA) approved mitomycin for intravesical solution (Zusduri®) for adults with LG-IR-NMIBC that has come back. This makes non-surgical chemoablation an FDA-approved option for this group.^2,4,6,7

The standard treatment for NMIBC is surgery to remove a tumor. This procedure is known as transurethral resection of bladder tumor (TURBT). After the surgery, a doctor may put cancer-killing drugs (chemotherapy) into the bladder as a liquid. This is a treatment called intravesical therapy. The liquid drug stays in your bladder for an hour or 2. Then it washes out when you urinate.^2,4,7

Zusduri is a different type of intravesical therapy. It goes into the bladder through a thin tube (catheter) as a cold liquid. At body temperature, it turns into a gel. The gel holds the chemotherapy drug mitomycin in the bladder longer than a standard liquid. It slowly dissolves over several hours and then leaves the body through the urine. This longer contact gives the drug more time to destroy tumors without surgery. Zusduri is given once a week for 6 weeks.^4,6,7

Chemoresection is also different from the type of chemo injected into the veins. That type, called intravenous chemo, works throughout your entire body and can damage healthy tissue.⁶

What are the benefits of chemoresection?

In the phase 3 ENVISION trial, 78 percent of people with recurrent LG-IR-NMIBC had a complete response 3 months after starting Zusduri. This means doctors could not find any cancer. Of those, 79 percent were still cancer-free at least 12 months later.^2,4

The treatment helps people with LG-IR-NMIBC avoid repeated TURBT procedures, which usually require medicine that puts them to sleep (general anesthesia). This means less risk for people who are more likely to have complications from surgery, such as older adults and people with other health problems. In the ENVISION trial, about 2 out of 3 people were age 65 or older.^1,4-6

Lower cost may be another benefit of this type of therapy. With TURBT, there are operating room costs, hospital stays, and other related charges. Expenses can add up, especially if the cancer keeps coming back. Chemoresection may lower some of these costs. Costs vary, so ask your care team and insurance provider what to expect.^1,5

What are the possible side effects of Zusduri?

Zusduri has known side effects. The most common include:⁴

• Changes in blood tests – Such as higher kidney (creatinine) and potassium levels or lower hemoglobin.
• Painful urination – Burning or pain when you urinate.
• Urinary tract infection (UTI) – An infection in the bladder or urinary tract.
• Blood in the urine – Also called hematuria.

Serious side effects happened in about 12 out of 100 people in the trial. These included problems emptying the bladder (urinary retention).²

Tell your doctor if you have had a hole or tear in your bladder wall (perforation). Zusduri can also harm an unborn baby. People who could get pregnant, or whose partners could, need birth control during and after treatment.⁴

Zusduri may turn your urine violet to blue after each treatment. You may also see bits of gel in your urine for up to a day. For 24 hours after each treatment:⁴

• Sit down on the toilet to urinate.
• Flush the toilet several times after each use.
• Wash your hands and genital area with soap and water after each time you urinate.
• Avoid getting urine on your skin.

These are not all the possible side effects of Zusduri. Talk to your doctor about what to expect when taking Zusduri. You also should call your doctor if you notice any changes that concern you when taking Zusduri.

Before beginning treatment for bladder cancer, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.

Chemoresection in bladder cancer care today

Chemoresection is now part of care for recurrent LG-IR-NMIBC. Experts list it alongside TURBT, in-office procedures, and close monitoring as options for recurrent low-grade cancer. You and your doctor should choose together based on how well each option works, side effects, cost, and your wishes.⁵

Zusduri is approved only for adults whose LG-IR-NMIBC has come back, so it is not right for everyone. The cancer can still return after treatment. You will still need regular checkups with a cystoscopy, a test that uses a thin scope to look inside your bladder.^3,4

Talk to your urologist about whether chemoresection is an option for you.