David Morris, MD, discusses significance of early elution with intravesical drug system

In this interview, David Morris, MD, FACS, discusses expert panel recommendations on intravesical drug-releasing systems in bladder cancer,¹ highlighting early drug release dynamics, tolerability, and practical strategies for optimizing patient comfort. Specifically, Morris highlights that the majority (77%) of drug delivery with the gemcitabine intravesical system (Inlexzo) occurs early in the treatment cycle,² offering reassurance for both physicians and patients.

Morris is the president of Urology Associates of Nashville in Tennessee.

The gemcitabine intravesical system (Inlaxzo) was approved in September 2025 for BCG-unresponsive non–muscle invasive bladder cancer with carcinoma in situ with or without papillary tumors. Data has shown that approximately 77% of the drug is released and excreted within the first week of the 3-week treatment cycle,² a factor that Morris said meaningfully informs clinical decision-making. This early release provides reassurance that even in the rare event a patient cannot tolerate the device for the full duration, they are still likely to derive therapeutic benefit. He noted that premature removal was uncommon in clinical trials of the system, with over 90% of patients successfully maintaining the device and placement success rates approaching 99%, underscoring the feasibility of this approach in practice.

Regarding safety, Morris explained that both clinical trial and real-world data demonstrate a favorable tolerability profile for intravesical drug-releasing systems. Most adverse events are low grade (grade 1 or 2) and consistent with expected local urinary symptoms, such as frequency, dysuria, urgency, and occasional hematuria. While urinary tract infections can occur, particularly with bladder instrumentation, these risks can be mitigated through standard catheterization protocols and, when appropriate, prophylactic antibiotic strategies.

He added that the publication reflects extensive experience from high-volume implanters across both clinical trials and real-world settings, encompassing years of data and hundreds of device placements. Urologists are generally well equipped to manage these adverse effects, drawing on strategies commonly used for patients with ureteral stents. Importantly, Morris noted that patients may be more willing to tolerate transient discomfort when they understand the therapy is actively treating their cancer, which can support adherence to the prescribed treatment course.

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. Inlexzo. Johnson & Johnson. Accessed April 2, 2026. https://www.inlexzohcp.com/