New chemotherapy delivery devices in bladder cancer management

Bladder cancer is a significant public health and economic burden, with non-muscle-invasive bladder cancer comprising around 75% of diagnoses. Standard of care involves transurethral resection of the bladder followed by adjuvant therapies such as BCG or Mitomycin-C (MMC). With BCG facing shortages and nonetheless many side effects, there is a need to explore alternative treatments that are equally or more effective, less toxic, and more readily available. This article reviews novel device therapies for NIMBC, focusing on electromotive drug administration of MMC (EMDA-MMC), chemohyperthermia devices, intravesical drug delivery device like TAR-200 (GemRIS system), and reverse thermal gel containing MMC (UGN-102). EMDA-MMC enhances drug penetration into bladder tissue, showing promising outcomes in preventing recurrence and progression. Chemohyperthermia devices utilize hyperthermia to potentiate the cytotoxic effects of chemotherapy. RITE (Synergo®) and HIVEC are two devices that have shown promising results. Investigational device, TAR-200 (GemRIS system), is an implantable gemcitabine-releasing medical device, offering a novel approach to prolong drug exposure and minimize side effects. Reverse thermal gel containing MMC, UGN-102, is another innovative treatment option designed to increase urinary drug dwell time and improve efficacy. Ongoing clinical trials aim to further evaluate the safety and efficacy of these novel device therapies. Challenges such as small sample sizes and heterogeneity between studies populations exist, but these innovative approaches offer potential advancements in non-muscle-invasive bladder cancer management, focusing on quality of life and improved oncological outcomes.