Christopher Pieczonka, MD, on best practices with intravesical drug delivery systems

In the following video, Christopher M. Pieczonka, MD, discusses practical strategies to optimize tolerability and minimize early discontinuation with indwelling intravesical drug-releasing systems (iDRS) in BCG-unresponsive bladder cancer.¹ Pieczonka is the chief executive officer and director of clinical research at Associated Medical Professionals in Syracuse, New York.

To begin the discussion, Pieczonka notes that the gemcitabine intravesical system (Inlexzo) is currently approved for patients with BCG-unresponsive carcinoma in situ with or without papillary disease. This iDRS provides continuous, low-dose intravesical delivery of gemcitabine to enhance drug exposure and improve complete response rates.

Pieczonka emphasized that drug discontinuation due to treatment-related adverse events in the study of the gemcitabine intravesical system was low, at around 3.5% in the pivotal cohort.² However, he highlighted several counseling and prophylactic strategies that may help improve treatment adherence and optimize outcomes in patients with bladder cancer.

Setting expectations through clear communication about treatment goals, potential adverse effects, and the importance of completing therapy can improve adherence. He noted that ongoing dialogue is critical, particularly given the need to maintain the device in situ for several weeks. From a procedural standpoint, strict adherence to sterile technique during device insertion and removal is essential. Reinforcing sterile practices across the care team may help reduce complications such as urinary tract infections, which can significantly impact patient comfort and treatment continuity.

In addition to counseling and procedural best practices, Pieczonka described several prophylactic and supportive strategies to mitigate adverse events. These include consideration of prophylactic antibiotics—commonly cephalosporins in non-penicillin-allergic patients—at the time of device manipulation, as well as routine urine culture monitoring to detect occult infection. Symptom management with beta-3 agonists or anticholinergics may help address bladder irritability, while adequate hydration (approximately 1500 mL daily) is important to ensure proper device function and drug dispersion within the bladder. Attention to bowel regularity, including the use of stool softeners when needed, may further reduce patient discomfort. Collectively, these measures support treatment persistence, with most patients ultimately able to complete therapy despite manageable adverse effects.

REFERENCES

1. Pradere B, Schuit M, Guerrero-Ramos F, et al. Side effect management and procedural best practices with indwelling intravesical drug-releasing systems in the treatment of bladder cancer: recommendations from expert panels. Curr Opin Urol. 2026;36(1):123-133. doi:10.1097/MOU.0000000000001350

2. Daneshmand S, Heijden MSV, Jacob JM, et al. TAR-200 for Bacillus Calmette-Guérin-unresponsive high-risk non-muscle-invasive bladder cancer: Results from the phase IIb SunRISe-1 study. J Clin Oncol. 2025:101200JCO2501651. doi:10.1200/JCO-25-01651