(UroToday.com) Most patients newly diagnosed with bladder cancer have non-muscle invasive disease (NMIBC). For patients with intermediate or high-risk NMIBC and those with carcinoma in situ (CIS), adjuvant treatment with BCG is guideline-recommended on the basis of proven benefits in disease recurrence. While BCG is efficacious, many patients eventually develop BCG-unresponsive disease and are at risk for tumor recurrence and progression. For many years, there have been very limited options for these patients. Radical cystectomy has remained the gold standard through numerous approaches including intravesical and systemic therapies have been investigated.