(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. For many years, there have been very limited options for these patients. Radical cystectomy has remained the gold standard though numerous approaches including intravesical and systemic therapies have been investigated. Two such approaches are the use of systemic pembrolizumab (which is FDA approved) and salvage intravesical chemotherapy. In a plenary abstract presentation in the Rapid Abstract Session: Urothelial Carcinoma and Rare Tumors session at the 2021 ASCO GU Cancers Symposium, Dr. Vidit Sharma and colleagues presented a cost-effectiveness analysis comparing pembrolizumab with radical cystectomy and salvage intravesical chemotherapy (using gemcitabine-docetaxel as the prototypical regimen) for patients with BCG-unresponsive CIS.