Mitomycin for intravesical treatment of low-grade intermediate-risk non-muscle invasive bladder cancer

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.