How to cite: Lerner, Seth P. “What’s in the Pipeline for Bladder Cancer Management in 2026?” November 2025. Accessed Mar 2026. https://grandroundsinurology.com/whats-in-the-pipeline-for-bladder-cancer-management-in-2026/
Summary
Seth P. Lerner, MD, FACS, Professor of Urology and Vice-Chair for Faculty Affairs, Baylor College of Medicine, Houston, Texas, provides an overview of innovations expected to impact bladder cancer management by 2026. He highlights advances in artificial intelligence (AI), gene therapy, intravesical delivery systems, and immunotherapy integration across non-muscle invasive and muscle-invasive disease.
He discusses novel intravesical agents, beginning with UGN-102 (gel mitomycin), a reverse-thermal gel allowing prolonged mucosal drug exposure. Following FDA approval for upper tract use in 2022, trials such as ENVISION explore chemoablation for bladder tumors, potentially reducing the need for TURBT.
Dr. Lerner reviews gene therapy products, including cretostimogene (GM-CSF adenovirus). He notes the forthcoming SWOG Tokyo Bacillus Calmette-Guérin (BCG) strain study results, which may be practice-changing if priming improves immune response. Additional innovations include TARIS-Janssen’s TAR-200 drug-eluting pretzel device and checkpoint inhibitors in SunRISe and CREST trials, reporting unprecedented complete response rates.
In muscle-invasive disease, he summarizes positive results from NIAGARA (gemcitabine plus cisplatin plus durvalumab) and emerging data integrating ctDNA monitoring to guide adjuvant therapy, as in IMVigor011. These trials indicate that ctDNA positivity predicts recurrence and may help tailor immunotherapy. Dr. Lerner asserts that rapid innovation from AI diagnostics to intravesical delivery and molecular biomarkers will reshape bladder cancer treatment by 2026.
ABOUT THE AUTHOR
Seth P. Lerner, MD, FACS, is Professor of Urology and Vice-Chair for Faculty Affairs in the Scott Department of Urology at the Baylor College of Medicine in Houston, Texas. He holds the Beth and Dave Swalm Chair in Urologic Oncology. Dr. Lerner is the Director of Urologic Oncology and the Multidisciplinary Bladder Cancer Program, also at Baylor.
Dr. Lerner earned his medical degree from the Baylor College of Medicine, completed a surgical internship at Virginia Mason Hospital in Seattle, and returned to Baylor for his residency training. He completed a two-year fellowship at the University of Southern California in Urologic Oncology and Reconstructive Surgery and joined the full-time Baylor faculty in 1992.
