Intravesical mitomycin C (MMC) is a cornerstone therapy for non-muscle-invasive bladder cancer (NMIBC), effectively reducing recurrence in low-grade intermediate-risk patients. We conducted a narrative synthesis of randomized and prospective studies evaluating intravesical MMC across three clinical settings: single immediate post-transurethral resection of bladder tumor (TURBT) instillation, adjuvant multiple instillations, and chemoablation in low- and intermediate-risk NMIBC. Single immediate instillation after uncomplicated TURBT effectively reduces early recurrences in low-risk NMIBC. In intermediate-risk patients, available evidence indicates that adjuvant MMC reduces recurrence by 30-50% versus TURBT alone, with recurrence-free survival gains of 20-35% and minimal systemic toxicity; maintenance cycles further enhance durability when consistently administered. Device-assisted strategies, may further improve recurrence control. For selected patients, MMC-based chemoablation offers a non-surgical outpatient option with encouraging tumor response rates. MMC offers a favorable balance of oncologic efficacy, safety, and logistical feasibility. Evidence supports routine post-TURBT use in low-risk disease, adjuvant benefit in intermediate-risk patients, and emerging chemoablation for selected recurrences, reinforcing MMC as a reliable, accessible component of modern NMIBC management.
Bladder cancer is one of the most common cancers of the urinary tract. Many patients are diagnosed with early-stage disease that has not invaded the bladder muscle. For these patients, treatment aims to remove visible tumors while reducing the risk of recurrence and preserving bladder function.Mitomycin C (MMC) is a chemotherapy drug that can be delivered directly into the bladder. This review summarizes how MMC is currently used for patients with low- and intermediate-risk non–muscle-invasive bladder cancer. MMC can be given immediately after tumor removal surgery, as a longer-term preventive treatment, or as a non-surgical option to destroy small recurrent tumors (chemoablation).Evidence shows that a single dose of MMC after surgery can lower the chance of early tumor recurrence. Repeated MMC treatments can also reduce recurrence risk in patients with intermediate-risk disease, with fewer side effects compared with some alternative treatments such as bacillus Calmette-Guérin (BCG).New approaches, including gel-based formulations of MMC that stay longer in the bladder, have shown promising short-term results in carefully selected patients. However, long-term outcomes and the best follow-up strategies are still uncertain.Overall, MMC remains an important and well-tolerated treatment option, but treatment decisions should be individualized based on tumor risk, patient characteristics, and available evidence.
Future oncology (London, England). 2026 Apr 27 [Epub ahead of print]
Ludovica Cella, Alessio Finocchiaro, Aleksander Ślusarczyk, Wojciech Krajewski, Jorge Caño Velasco, José Daniel Subiela, Francesco Claps, Elisabeth Grobet-Jeandin, Francesco Del Giudice, Andrea Gallioli, Ekaterina Laukhtina, Gautier Marcq, Andrea Mari, Luca Afferi, Simone Albisinni, Francesco Soria, Rodolfo Hurle, Marco Paciotti, Matteo Ferro, Sisto Perdonà, Laura S Mertens, Marco Moschini, Benjamin Pradere, Roberto Contieri, European Association of Urology - Young Academic Urologists (EAU-YAU), Urothelial Carcinoma Working Group
Department of Biomedical Sciences, Humanitas University, Milan, Italy., Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland., Department of Urology and Oncologic Urology, Wrocław Medical University, Wroclaw, Poland., Department of Urology, Clinica Universidad de Navarra, Cancer Center, Pamplona, Spain., Department of Urology, Instituto Ramón y Cajal de Investigación Sanitaria, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain., Oncological Urology, Veneto Institute of Oncology IRCCS, Padua, Italy., Division of Urology, Geneva University Hospitals, Geneva, Switzerland., Department of Maternal Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy., Department of Urology, Fundació Puigvert, Barcelona, Spain., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Department of Urology, Claude Huriez Hospital, CHU Lille, Lille, France., Department of Urology, University of Florence, Careggi Hospital, Florence, Italy., Department of Urology, Aarau Kantonsspital, Aarau, Switzerland., Urology Unit, Department of Surgical Sciences, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy., Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy., Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy., Unit of Urology, Department of Health Science, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy., Urology Department, National Cancer Institute, IRCCS "G. Pascale", Naples, Italy., Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy., Department of Urology UROSUD, La Croix Du Sud Hospital, Quint-Fonsegrives, France.