Perspective Chapter: Intravesical Chemohyperthermia with Mitomycin C in BCG-Unresponsive Nonmuscle-Invasive Bladder Cancer – Clinical Outcomes and Emerging Perspectives
<p>Non–muscle-invasive bladder cancer (NMIBC) is characterized by high recurrence rates and a persistent risk of progression despite appropriate intravesical therapy. Bacillus Calmette–Guérin (BCG) remains the standard adjuvant treatment for high-risk disease; however, a considera...
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| Format: | Book Chapter |
| Language: | English |
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IntechOpen
2026
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| Online Access: | https://www.intechopen.com/chapters/1246882 |
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| Summary: | <p>Non–muscle-invasive bladder cancer (NMIBC) is characterized by high recurrence rates and a persistent risk of progression despite appropriate intravesical therapy. Bacillus Calmette–Guérin (BCG) remains the standard adjuvant treatment for high-risk disease; however, a considerable proportion of patients experience recurrence or progression even after adequate BCG exposure. This clinical scenario, defined as BCG-unresponsive disease, represents a significant therapeutic challenge in contemporary urologic oncology. Radical cystectomy is considered the oncological gold standard in this setting, offering the highest likelihood of durable disease control. Nevertheless, many patients are either medically unfit for surgery due to comorbidities or decline cystectomy because of its substantial morbidity, potential complications, and negative impact on quality of life.As a result, bladder-preserving salvage strategies have gained increasing clinical interest, particularly for carefully selected patients seeking less invasive alternatives. Among these, intravesical chemohyperthermia (CHT) with mitomycin C (MMC) has emerged as a promising therapeutic approach. This modality combines controlled intravesical heating with chemotherapy to enhance drug delivery and cytotoxic efficacy. Hyperthermia has been shown to increase urothelial permeability, improve drug penetration into the bladder wall, inhibit DNA repair mechanisms, and potentiate the antitumor effects of MMC through synergistic interactions at the cellular level.Accumulating clinical evidence suggests that MMC-based CHT may provide meaningful disease control, reduce recurrence rates, and achieve acceptable safety outcomes in selected patients with BCG-unresponsive NMIBC, particularly those with papillary tumors and limited disease burden. This perspective chapter discusses the biological rationale, current clinical evidence, optimal patient selection criteria, and the practical positioning of CHT within contemporary bladder-preserving treatment algorithms, while also highlighting future research directions and potential combinations with emerging systemic and intravesical therapies in modern clinical practice today.</p> |
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| ISBN: | 978-1-80631-193-4 |
| DOI: | 10.5772/intechopen.1015567 |