NMIBC treatment success: Why less frequent dosing and adherence matter

Chauhan is a urologist with Conrad Pearson Clinic in Germantown, Tennessee, as well as a consultant/adviser for Ferring Pharmaceuticals.

True treatment success isn't measured by clinical outcomes alone. The patient experience on a therapy is a quintessential measure of their well-being. Therapies that fit seamlessly into a patient’s daily life are highly sought after by both patients and physicians. Frequent appointments, long commutes, and (AEs) events can create significant burdens, putting adherence and therefore efficacy of the therapy at risk—especially when treatments require frequent or prolonged visits. In my experience, treatment schedules that demand less frequent dosing, such as quarterly administration, can significantly improve patient compliance and support long-term outcomes.

As a urologist treating patients with bladder cancer, I recognize that treatment adherence is a significant challenge. These patients are already vulnerable—physically, emotionally, and often financially—due to the toll the disease takes. When treatments are burdensome, inconvenient, or come with significant AEs, adherence tends to taper off.¹

Newly diagnosed patients considering their treatment options routinely ask 4 key questions: “Will it work?” “Will it hurt?” “How is it given?” and “What are the side effects?” These concerns underscore how patients evaluate both the clinical benefit of treatment and how it aligns with their lives. Patients increasingly choose treatment options that align with their individual needs, considering factors that affect their daily lives, including regimen complexity, medication costs, and access to care.^2,3 In other words, convenience can be critical to treatment adherence.⁴

In bladder cancer—and particularly in non–muscle invasive bladder cancer (NMIBC)—traditional treatment options have long been limited to BCG, chemotherapy, and radical cystectomy.^5-7 Each of these treatments has their benefits and considerations that may affect how they are used in clinical practice. For years, the next course of treatment typically recommended for patients who do not respond to BCG was partial or full cystectomy. Although this procedure is still the standard of care today and offers survival benefit, it can also be life-altering.

BCG, the standard therapy for NMIBC for over 40 years,⁸ is often effective initially, but approximately half of patients experience disease recurrence after an induction course.⁹ On the other hand, intravesical chemotherapy can be effective for preventing recurrence and progression of NMIBC. Today, the landscape of NMIBC is evolving with the entrance of additional potentially bladder-sparing options. Newer therapies are providing alternatives that expand choices for patients and physicians.

An example of this treatment advancement is nadofaragene firadenovec-vncg (Adstiladrin),a novel intravesical gene therapy for adults with BCG-unresponsive NMIBC with carcinoma in situ, with or without papillary tumors.¹⁰ Nadofaragene is administered once every 3 months in the urologist’s office via an intravesical instillation that takes about an hour. This quarterly dosing can potentially minimize disruption to patients’ daily lives by reducing appointment frequency.

Because the treatment is localized to the bladder, systemic AEs are limited,¹¹ and many patients can return to normal activities the same day. For patients already navigating the emotional and logistical challenges of cancer, a simplified treatment schedule may offer patients a more manageable approach to care.

The field of bladder cancer treatment is seeing significant innovation and a growing pipeline of new therapies, particularly for NMIBC. These advancements include novel intravesical drug delivery systems, immune checkpoint inhibitors, and targeted therapies. These emerging therapies are designed to improve clinical outcomes and expand treatment options for individuals with this disease.¹²

In my experience, when a treatment is well-tolerated and given on a predictable schedule, patients are more likely to adhere to therapy and remain engaged in long-term follow-up. I have also observed this can influence how patients approach their ongoing care.

For me, true success goes beyond clinical metrics—it’s about how well a treatment fits into a patient’s life, empowering the patient to stay engaged in their care, even while managing a serious disease.

REFERENCES

1. Gaylis FD, Emond B, Manceur AM, et al. Adherence to first-line intravesical Bacillus Calmette-Guérin therapy in the context of guideline recommendations for US patients with high-risk non-muscle invasive bladder cancer. JHEOR. 2024:11(2):109-117. doi:10.36469/jheor.2024.124208

2. Brown MT, Bussell JK. Medication adherence: WHO cares?. Mayo Clinic Proceedings. 2011;86(4): 304-314. doi:10.4065/mcp.2010.0629

3. Baryakova TH, Pogostin BH, Langer R, McHugh KJ. Overcoming barriers to patient adherence: the case for developing innovative drug delivery systems. Nat. Rev. Drug. Discov. 2023;22(5):387-409. doi:10.1038/s41573-023-00670-0

4. Aggarwal D, Sreenivasan SK, Kalra S, et al. Unraveling nonadherence in nonmuscle invasive bladder cancer follow-up in South Indian population: Factors, consequences, and strategies for improvement. JASU. 2024;1(2):49-57. doi:10.4103/JASU.JASU_9_24

5. Di Lorenzo G, Perdonà S, Damiano R, et al. Gemcitabine versus bacille Calmette-Guérin after initial bacille Calmette-Guérin failure in non-muscle-invasive bladder cancer: a multicenter prospective randomized trial. Cancer. 2010;116(8):1893-1900. doi:10.1002/cncr.24914

6. American Cancer Society. Treating Bladder Cancer. Available at: https://www.cancer.org/content/dam/CRC/PDF/Public/8560.00.pdf Accessed Nov. 2025.

7. Winters BR, Wright JL, Holt SK, et al. Health related quality of life following radical cystectomy: Comparative analysis from the Medicare Health Outcomes Survey. J Urol. 2018;199(3):669-675. doi:10.1016/j.juro.2017.08.111

8. Boorjian SA, Alemozaffar M, Konety BR, et al. Intravesical nadofaragene firadenovec gene therapy for BCG-unresponsive non-muscle-invasive bladder cancer: a single-arm, open-label, repeat-dose clinical trial. Lancet Oncol. 2021 Jan;22(1):107-117. doi:10.1016/S1470-2045(20)30540-4

9. Kamat AM, Lerner SP, O’Donnell M, et al. Evidence-based assessment of current and emerging bladder- sparing therapies for non–muscle-invasive bladder cancer after Bacillus Calmette-Guerin Therapy: a systematic review and meta-analysis. Eur Urol Onc. 2020;3(3):318-340. doi:10.1016/j.euo.2020.02.006

10. ADSTILADRIN. Prescribing Information. Ferring Pharmaceuticals. 2025. Available at: https://d2hu1op93domjx.cloudfront.net/wp-content/uploads/sites/12/2025/10/13222320/ADSTILADRIN-USPI-10.2025-CLEAN.pdf . Accessed Nov. 2025.

11. Narayan VM, Boorjian SA, Alemozaffar M, et al. Efficacy of intravesical nadofaragene firadenovec for patients with Bacillus Calmette-Guérin-unresponsive nonmuscle-invasive bladder cancer: 5-year follow-up from a phase 3 trial. J Urol. 2024;212(1):1-12. doi:10.1097/JU.0000000000004020

12. Filon, M., & Schmidt, B. New treatment options for non–muscle-invasive bladder cancer.2025. ASCO Educational Book, 45(2), e471942. doi:10.1200/EDBK-25-471942