Immunotherapy Plus BCG Shows Promise in NMIBC: Insights From POTOMAC and CREST
Key Points
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The POTOMAC and CREST trials showed that immunotherapy plus Bacillus Calmette-Guérin (BCG) therapy significantly improved outcomes for patients with non–muscle-invasive bladder cancer (NMIBC).
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These approaches should be used primarily in high-risk patients since they offer modest benefit with toxicity.
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Community oncologists should be trained since multidisciplinary care isn’t widely available to patients.
At an event coinciding with the 2026 ASCO Genitourinary Cancers Symposium, Vishesh Khanna, MD, of Oregon Health & Science University, and Ashish M. Kamat, MD, MBBS, of MD Anderson Cancer Center, discussed two pivotal phase 3 trials—POTOMAC and CREST—that have generated excitement in the bladder cancer community.
Both trials demonstrated that adding immunotherapy to BCG therapy significantly improved outcomes for patients with NMIBC. In the POTOMAC study, durvalumab was given, while sansanlimab was used in CREST. These studies showed for the first time that a therapy was superior to BCG alone, which has long been the standard of care.
However, the observed benefit was modest and accompanied by additional toxicity. Dr. Kamat recommended that the combination approach be considered primarily for patients with the highest-risk disease rather than broadly applied to all patients with NMIBC.
In clinical practice, urologists within academic centers collaborate closely with medical oncologists to oversee treatment and manage potential toxicities. But in rural or community settings, collaboration may be less accessible. Community urologists may need additional training to safely administer and manage immunotherapy, Dr. Kamat said.