Practical tips for AE management with the gemcitabine intravesical system

In this interview, Elizabeth Mobley, MD, of Urology Austin, discusses practical strategies for counseling patients receiving treatment with the gemcitabine intravesical system (Inlexzo) for non-muscle invasive bladder cancer. She also offers advice on managing treatment-related urinary symptoms and monitoring patients throughout the treatment course.

Mobley emphasized that patient education begins before the first device insertion and is reinforced at every treatment visit. She advises patients not to completely empty their bladder before the appointment because urine in the bladder facilitates device deployment and helps confirm proper catheter placement, particularly in men with enlarged prostates. After insertion, she counsels patients that, unlike traditional intravesical therapies, they do not need to retain the treatment for a prescribed period and can void normally when they feel the urge. Unlike BCG therapy, no special toilet disinfection is required. Mobley also discusses contraception recommendations for both men and women of childbearing potential while reassuring patients that there are no restrictions on sexual activity or close contact.

To manage treatment-related lower urinary tract symptoms, Mobley said hydration remains her first recommendation, followed by over-the-counter phenazopyridine for bothersome dysuria. For urgency, frequency, and incontinence, she commonly uses medications already familiar to urologists, with a preference for β3-adrenergic agonists over anticholinergics in older adults to minimize constipation, dry mouth, and cognitive adverse effects. Although she occasionally turns to additional therapies such as baclofen, diazepam, amitriptyline, trazodone, or duloxetine for more complex cases, she noted that most patients do not require these more advanced interventions.

Regarding follow-up, Mobley noted that the gemcitabine intravesical system treatment schedule itself provides frequent opportunities for monitoring, with device exchanges and cystoscopic evaluations every 3 weeks during the initial 6 months and every 12 weeks thereafter for a total of 14 doses over 2 years. These visits allow clinicians to assess treatment response while monitoring for adverse events. If symptoms arise between scheduled visits, she adjusts follow-up according to severity, using telephone or telemedicine visits for milder concerns and in-person evaluations when urine testing, laboratory work, imaging, or physical examination is needed. Rather than attempting to compensate for missed doses by altering the schedule, she prefers returning patients to the original treatment cadence. Mobley also credited her practice's nurse navigation program with improving adherence, reducing patient anxiety, and streamlining communication, describing nurse navigators as invaluable members of the multidisciplinary care team.