This study is testing a treatment for high-risk non-muscle-invasive bladder cancer (NMIBC). NMIBC means the cancer is in the bladder but hasn't spread to the muscle. The study is divided into three groups, or cohorts. In **Cohort A**, up to 125 people who haven't had a specific treatment called Bacillus Calmette-Guerin (BCG) will be tested. **Cohort B** will include 150 people who have had BCG treatment before. **Cohort CX** will have 50 people who didn't respond to BCG or had it before. Everyone in the study will receive a medicine called cretostimogene, and some in Cohort CX will also get gemcitabine. Treatments are given weekly for 6 weeks, then less often if the disease doesn't come back. Doctors will check the bladder every few months for 4 years.
- Participation lasts up to 4 years with regular check-ups.
- Participants must have had specific types of bladder cancer confirmed by doctors.
- Women who are pregnant or breastfeeding cannot join the study.