The treatment of non-muscle-invasive bladder cancer (NMIBC) remains a challenge owing to its increased tendency to recur and the possibility of progression to potentially dangerous muscle-invasive disease. Treatment outcomes by current therapeutic modalities are still not optimal. In recent years, there have been a number of substantive advances in the therapeutic options for the management of NMIBC. New chemotherapeutic drugs have been introduced, along with efforts made to improve the efficacy of existing agents and enhance delivery of agents to the bladder. There is also a growing trend toward combination of agents and multimodal therapy. Also of considerable interest are the investigation of newer approaches such as gene therapy, chemoenhancement and newer forms of immunotherapy. Here, we review the recent pre-clinical and clinical developments in the treatment of NMIBC, described in the broad categories of immunotherapy, chemotherapeutic agents, improved or device-assisted agent delivery and gene therapy.