(UroToday.com) After the recurrence of non-muscle invasive bladder cancer following Bacillus Calmette-Guerin (BCG) therapy, risk-stratified management directs patients toward radical cystectomy, clinical trial enrollment, and off-label use of intravesical chemotherapy. Many patients remain unfit for or unwilling to have major extirpative surgery. Pragmatically, 20% of patients with high-grade disease should have a cystectomy: from 2004-2013, only 5.7% of patients with high-grade non-muscle invasive bladder cancer underwent cystectomy in the NCDB.1 Thus, the identification of efficacious and safe alternatives to radical cystectomy is of paramount importance. At the American Urological Association 2020 Virtual Annual Meeting, Nathan Brooks, MD, and colleagues reported the findings of a large, multi-institutional cohort of patients receiving intravesical gemcitabine and docetaxel after BCG failure.