Key Clinical Trials Shaping the Future of Superficial High-Risk Bladder Cancer Management.

High-risk non-muscle-invasive bladder cancer (HR-NMIBC) represents a biologically aggressive disease state with substantial risk of recurrence, progression, and need for radical cystectomy. While intravesical Bacillus Calmette-Guérin (BCG) remains first-line for HR-NMIBC is standard of care, both recurrence and progression have led to the development of novel intravesical agents therapies. This article summarizes key clinical trials that are reshaping the management of HR-NMIBC, with particular emphasis on BCG-unresponsive disease. Approved intravesical and systemic agents demonstrate meaningful response rates and durable disease control in select patient populations. Emerging therapies and combination intravesical chemotherapies further expand the available therapies.