Witjes - Figure 34
Intravesical Chemotherapy in High Risk
FIG. 34: Intravesical chemotherapy in high-risk disease is still largely investigational. In the United States valrubicin was approved >30 years ago for a very narrow indication (intravesical therapy of BCG-refractory carcinoma in situ of the urinary bladder in patients not candidates for immediate cystectomy), but it does not appear to be widely used and it is not available outside the United States. Some newer drugs might be applicable. Gemcitabine is used in invasive bladder cancer and has also been used as intravesical therapy in high-risk NMI bladder cancer (See following Figure).
