Valstar®, an intravesical instillation of valrubicin (AD 32), is a semisynthetic anthracycline (doxorubicin) derivative. It is the only product that has been approved by the US FDA to treat bacillus Calmette-Guérin (BCG)-refractory carcinoma in situ (CIS) of the bladder, and has been used in the US and Canada in BCG-refractory bladder cancer patients who are not candidates for bladder removal.