Intravesical Chemotherapy

Chemotherapy is a type of treatment that includes powerful medicines to destroy actively growing cancer cells in the body. In systemic chemotherapy, the patient receives the medicine by mouth or is injected directly into a muscle or a vein (through an IV).^1-3

What is intravesical chemotherapy treatment?

In intravesical chemotherapy, the liquid medicine is delivered directly into the patient’s bladder through a catheter. A catheter is a small tube inserted into the bladder through the urethra, the tube-like organ that connects to the bladder so urine can pass out of the body. Systemic chemotherapy affects the entire body, but intravesical chemotherapy directly affects the cells in the lining of the bladder without affecting the entire body.^1,2

How is chemotherapy used to treat bladder cancer?

Intravesical chemotherapy is typically used to treat patients with early-stage bladder cancer. Bladder cancer cells generally start to grow in the urothelium, which is the thin layer of cells that line the inside of the bladder. In early-stage bladder cancer, the cancer cells are only located in or just under the bladder lining and have not grown into the muscle of the bladder wall.^1,2

Because it is delivered directly into the bladder, intravesical chemotherapy treatment is only effective against cancer cells located in the bladder lining. This type of treatment does not work against cancer cells that have grown deep into the bladder wall muscle or against cancer cells that are growing outside of the bladder in other organs or tissues.^1,2

Treatment after a TURBT

Intravesical chemotherapy is commonly used after a patient with non-muscle-invasive bladder cancer has had a surgical procedure called transurethral resection of bladder tumor (TURBT). During this procedure, the surgeon removes cancer cells from the lining of the bladder using a small, thin instrument inserted into the bladder through the urethra.^1,2

After the procedure, intravesical chemotherapy may be used to help destroy any remaining cancer cells in the bladder lining and to help potentially reduce the chance of the cancer cells growing back (recurring). Some patients may only receive a single dose of intravesical chemotherapy, while others may need multiple doses.^1,2

Which drugs can be delivered directly into the bladder?

Several different drugs can be used in intravesical chemotherapy treatment for early-stage bladder cancer. Mitomycin and gemcitabine are 2 of the most commonly used intravesical chemotherapy drugs.¹

Other intravesical chemotherapy drugs include:¹

• Docetaxel
• Valrubicin
• Epirubicin

Valrubicin (Valstar®) is approved by the US Food and Drug Administration (FDA) to treat a type of early bladder cancer called carcinoma in situ (CIS) that has not responded to BCG, for people who cannot safely have their bladder removed right away. Standard mitomycin and gemcitabine are FDA-approved to treat other cancers.^4-6

Some treatments listed here are not approved by the US Food and Drug Administration to treat bladder cancer. They may be approved for other conditions. A doctor may prescribe them “off-label” when evidence suggests they help. Talk to your doctor about what is right for you.

Newer forms of intravesical chemotherapy are designed to stay in the bladder longer. Both are FDA-approved for certain types of non-muscle invasive bladder cancer (NMIBC):^1,7-10

• Mitomycin for intravesical solution (Zusduri®) – This goes into the bladder through a catheter as a cold liquid. At body temperature, it turns into a gel that stays against the bladder lining for several hours. It is given once a week for 6 weeks. It is approved for adults with low-grade, intermediate-risk NMIBC that has come back.
• Gemcitabine intravesical system (Inlexzo®) – This is a small, flexible device shaped like a pretzel. It is placed in the bladder through a catheter and slowly releases gemcitabine for about 3 weeks. It is approved for adults with NMIBC with CIS that BCG has not helped.

Using drugs to destroy tumors instead of removing them with surgery is called chemoablation. In 2026, updated American Urological Association guidelines added chemoablation as one option for some people whose low-grade cancer comes back.¹¹

What are the benefits and side effects of chemo?

Side effects can vary depending on the specific treatment you are receiving. Chemotherapy medicines that are delivered through intravesical therapy tend to cause fewer side effects than systemic chemotherapy that affects the entire body. However, intravesical chemotherapy treatment can cause side effects such as bladder irritation or a burning sensation in the bladder, and blood in the urine.¹

The newer forms can also cause painful or frequent urination, urinary tract infections, and blood in the urine.^8,10

These are not all the possible side effects of intravesical chemotherapy. Talk to your doctor about what to expect when receiving this treatment. You should also call your doctor if you have any changes that concern you when receiving intravesical chemotherapy.

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.