What Patients Should Know About Expanding Options in Bladder Cancer

At the 2026 NCCN Annual Meeting, Dr. Charles Peyton sat down with CURE to discuss how the rapid expansion of treatment options is reshaping bladder cancer care.

As new therapies emerge, particularly for non-muscle invasive disease, clinicians and patients are faced with increasingly complex decisions regarding efficacy, cost, and accessibility. In this interview, Peyton highlights the importance of patient engagement, encouraging individuals to actively research and ask about available options.

Peyton is an associate professor in the University of Alabama at Birmingham (UAB) Department of Urology at the Heersink School of Medicine.

CURE: How are clinicians integrating new therapies into bladder cancer treatment?

Peyton: For patients, there are a lot of new therapies for bladder cancer out there. What I talked about today is non-muscle invasive bladder cancer, where the problem is usually recurrence. These tumors keep coming back.

Within the last six years, we have had five new medicines approved for the treatment of this disease in various states for non-muscle invasive bladder cancer. So there are a lot of options now for treatment, whereas before there weren't. Some of them are very, very expensive and have good and bad nuances to them in terms of what the patients would want or expect. That is a decision that patients are going to make with their provider in the context of the disease they have and what that provider has available.

These medicines are so expensive that patients are not going to see a provider that has everything available, because it is just too expensive to keep all of that available.

How are these treatment decisions being personalized, and how can patients better work with their care team to make sure it is the right decision for them?

Patients need to ask about new therapies for non-muscle invasive bladder cancer if that is what they have, and they can certainly look for it online, too. These new medicines are available all over the internet. Doing some research before you see your provider for non-muscle invasive bladder cancer is really helpful.

The one piece of advice I would have for patients with specific non-muscle invasive bladder cancer: most of those medicines, the urologist is going to be more familiar with them than the medical oncologist in a lot of situations. That's not totally true, but in most situations, the urologist is the one delivering a lot of these treatments because they are intravesical treatments, meaning they are medicines in the bladder. In the metastatic setting or the muscle-invasive setting, that's a different story.

Thank you. Now, what challenges remain in managing advanced diseases that you'd like to highlight today?

Well, with advanced disease, like muscle-invasive bladder cancer, locally advanced, or metastatic disease, it's always a challenge of tailoring the therapy to the patient, and tailoring not over-treating but not under-treating at the same time. We have an explosion of treatments for even advanced disease at this point. However, that nuanced discussion with each patient about which one is going to be best for them is rooted in the biology of the disease they have and also where they are in terms of staging and disease progression.

So, again, that is a nuanced discussion between the provider and the patient, but there are so many options now that we can usually fit somebody into a nice category that will be helpful.

What would you like patients to take away from this conversation?

That there are a lot of new options out there for non-muscle invasive bladder cancer, and they shouldn't be bashful about asking about them. There are a lot of nuances as to whether or not you can qualify for those medicines because they are enormously expensive. So, patients have to understand that just because you hear about it doesn't necessarily mean that you're eligible for that treatment.

It's very nuanced. That doesn't mean you shouldn't ask or inquire about them when you are diagnosed with non-muscle invasive bladder cancer or recurrent non-muscle invasive bladder cancer, more specifically, but that would be my main suggestion.

Transcript has been edited for clarity and conciseness.

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