Sandip Prasad, MD, on the safety profile of mitomycin intravesical solution

In this video, Sandip M. Prasad, MD, MPhil, discusses the safety profile of mitomycin intravesical solution (Zusduri) for low-grade intermediate-risk non–muscle-invasive bladder cancer (NMIBC).¹ Prasad is the vice chair of urology and director of the genitourinary surgical oncology program at Atlantic Health Morristown Medical Center and Garden State Urology.

Prasad explains that dysuria, hematuria, and urinary tract infections are commonly encountered with intravesical therapies. Although these events may be associated with treatment, the contribution of the therapy itself vs repeated catheterization is unclear. He notes that urology teams are generally familiar with managing these symptoms in clinical practice.

In the ENVISION trial, the most common adverse events (occurring in at least 5% of patients) were dysuria, hematuria, UTI, pollakiuria, fatigue, and urinary retention. Serious adverse events occurred in 29 of 240 patients (12.1%), with 2 patients experiencing treatment-related serious adverse events: urinary retention and urethral stenosis. Both events resolved. Prasad emphasizes that clinicians should consider these findings when counseling patients about potential complications and the likelihood of symptom resolution.

He also highlights the limited duration of treatment, which consists of 6 weekly instillations, as a consideration when discussing tolerability with patients. Common urinary adverse events were generally mild to moderate and resolved or were resolving, supporting the importance of setting expectations about temporary symptoms and discussing how they can be managed during treatment.

“For the things that we do see at the time of instillation, they typically resolve,” he noted. “They're associated with the treatments themselves, but they're not typically long-term changes that we're seeing in patients.”

REFERENCE

1. Prasad SM, Shishkov D, Mihaylov NV, et al. Primary chemoablation of recurrent low-grade intermediate-risk nonmuscle-invasive bladder cancer With UGN-102: A single-arm, open-label, phase 3 trial (ENVISION). J Urol. 2025;213(2):205-216. doi:10.1097/JU.0000000000004296