A recently published phase 3 trial by Arends, MD, from the University Medical Center Nijmegen in the Netherlands, showed that thermal perfusion chemotherapy (heat + intravesical chemotherapy) is more effective than conventional BCG infusion in the treatment of intermediate-risk non-muscle invasive bladder cancer. With the current worldwide shortage of BCG and the dilemma of treating bladder cancer, this treatment may be an alternative to BCG to some extent, reducing the risk of cancer recurrence while maximizing bladder function in patients. Between 2002 and 2012, researchers enrolled 142 patients in 11 centers in Europe and Israel and randomized them to 12 months of treatment in both the heat-infused chemotherapy and BCG groups. The bladder wall was heated to 42 degrees using a Synergo device. Patients in the heat-infused chemotherapy group received 6 weeks of heat-infused chemotherapy (heating + 20 mg mitomycin) and 6 weeks of maintenance therapy; patients in the BCG group received 6 weeks of BCG therapy and 9 weeks of maintenance therapy. Intention-to-treat analysis showed that the heat-infused chemotherapy group was more effective than the BCG group, with recurrence-free survival rates of 80.0% and 66.0% at 24 months, respectively, with no significant difference in metastasis rates between the two groups, which were well tolerated by patients. This study confirms the superiority of heat-infused chemotherapy over BCG and the first signs of immunotherapy for bladder cancer.