# Intravesical therapy (BCG and bladder instillations)

Source: https://onco.cc/terms/intravesical-therapy/  
OnCo record `intravesical-therapy` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Putting a drug directly into the bladder through a catheter and leaving it for an hour or two, so it treats the lining without going round the body. BCG, a weakened tuberculosis vaccine, has been the most effective such drug for 45 years.

## Summary

A single instillation of mitomycin or gemcitabine after TURBT reduces recurrence of low-risk tumours; six weekly BCG instillations plus maintenance for 1-3 years (SWOG schedule) is standard for intermediate- and high-risk NMIBC and carcinoma in situ, provoking a local immune response. BCG shortages have forced reduced-dose and alternative schedules. For BCG-unresponsive disease, intravesical nadofaragene firadenovec (gene therapy), cretostimogene (oncolytic virus), the TAR-200 gemcitabine-releasing device and systemic pembrolizumab now compete with cystectomy; adding durvalumab to BCG (POTOMAC, 2026) extended disease-free survival in high-risk disease. Chemohyperthermia and electromotive delivery are other enhancements.

## Fields

- Kind: Term
- Last checked: 2026-09-09
- Also known as: intravesical; intravesical BCG; BCG; Bacillus Calmette-Guérin; bladder instillation; instillation; instillations; intravesical chemotherapy; intravesical gemcitabine; intravesical mitomycin; BCG maintenance; BCG shortage; TAR-200; intravesical gene therapy; BCG shortages; bladder instillations

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/BCG_vaccine#Cancer
- Wikipedia: https://en.wikipedia.org/wiki/BCG_vaccine#Cancer

## Connected records

- terms: [Carcinoma in situ (CIS)](https://onco.cc/terms/carcinoma-in-situ/), [Non-muscle-invasive vs muscle-invasive bladder cancer (NMIBC / MIBC)](https://onco.cc/terms/nmibc-vs-mibc/), [Radical cystectomy](https://onco.cc/terms/cystectomy/), [Transurethral resection of bladder tumour (TURBT)](https://onco.cc/terms/turbt/)
- cancers: [Bladder & urothelial cancer](https://onco.cc/cancers/urothelial/)
- fronts: [Immunotherapy](https://onco.cc/fronts/immunotherapy/)

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