Shreyas Joshi, MD, recaps AUA session on chemotherapy vs novel NMIBC options

In an interview with Urology Times®, Shreyas S. Joshi, MD, MPH, recapped a session from the 2025 American Urological Association (AUA) Annual Meeting, titled, “Controversies in Urology: Double Intravesical Chemotherapy is Preferred Over New FDA Approved Agents for BCG Unresponsive NMIBC: The Price of Success.” Joshi is an assistant professor of urologic oncology at Emory University in Atlanta, Georgia.

He explained, “Both sides made arguments as to, in this complex disease state—BCG-unresponsive, high-risk, non-muscle invasive bladder cancer—what is the optimal go-to choice for urological oncologists or urologists in general when trying to first start treating this disease.”

On the chemotherapy side, the arguments centered on the fact that there is good, retrospective data showing encouraging efficacy of gemcitabine/docetaxel. Additionally, there are known benefits to choosing this treatment regimen, including accessibility and cost-effectiveness compared with newer options.

On the other hand, Joshi explained that arguments in favor of using these newer FDA approved therapies highlighted the prospective, multinational data showing the efficacy and safety of these agents in diverse populations. Further, many of these agents have a favorable dosing regimen that offers convenience for patients. Joshi did acknowledge, however, the significant cost associated with these newer treatment modalities.

Moving forward, Joshi alluded to the idea that the field is still in need of ways to determine who may benefit from which option. It is likely not that one is better than another, but rather that we need to be able to choose which option may be best for each patient.

He added, “It is likely that more and more, these newer agents are going to play earlier and more central roles in the early treatment of BCG-unresponsive disease.”