Durvalumab in NMIBC Care / NMIBC 06/11/2026

Real-World Integration, Immune Toxicity, and the Future of Multidisciplinary NMIBC Care

High-quality professional portrait of a confident woman in business attire, showcasing leadership and expertise in healthcare or corporate settings. Shilpa Gupta, MD Amit Patel, MD A professional male oncologist in a suit smiling against a gray background for cancer treatment and healthcare research. Neal Shore, MD, FACS Smiling man with beard wearing a white shirt, professional headshot, suitable for oncology or cancer research content, emphasizing healthcare and medical expertise. Rahul Gosain, MD, MBA Oncologist smiling in white coat, highlighting cancer research and treatment expertise, with a bow tie, in a bright medical setting. Rohit Gosain, MD

Key Points

  • Durvalumab was added on top of standard full BCG induction and maintenance therapy.
  • Immune-related adverse events require proactive monitoring in a curative setting.
  • Multidisciplinary collaboration between urology and medical oncology is essential for safe delivery.
  • BCG shortages may complicate care but should not lead to omission of BCG when possible.

The final segment of this Clinical Insights session, coinciding with the 2026 American Society of Clinical Oncology (ASCO) Annual Meeting, focused on the real-world practice implementation of durvalumab plus BCG, including toxicity management, workflow between specialties, and ongoing challenges such as BCG shortages. Oncology Brothers podcast cohosts Rahul Gosain, MD, MBA, of Wilmot Cancer Institute, and Rohit Gosain, MD, of Roswell Park Comprehensive Cancer Center, were joined by Shilpa Gupta, MD, of Cleveland Clinic; Amit Patel, MD, of Duly Health and Care; and Neal Shore, MD, FACS, of Carolina Urologic Research Center. 

Dr. Shore emphasized that most patients in the trial received full induction and maintenance BCG alongside durvalumab, reinforcing that immunotherapy is intended to complement, not replace, BCG. Dr. Gupta then reviewed immune-related adverse events associated with checkpoint inhibitors, highlighting that while most patients tolerate therapy well, serious toxicities such as myocarditis, neurologic syndromes, and endocrine dysfunction can occur. She stressed that this is a curative-intent setting, making early recognition and multidisciplinary care essential to prevent avoidable harm.

The panel discussed the practical reality of integrating care across urology and medical oncology, noting that most practices will require shared management models. In many community settings, medical oncologists will play a central role in toxicity monitoring and systemic therapy oversight, while urologists remain essential for procedural care and disease surveillance.

The discussion also addressed BCG shortages, with Dr. Shore describing evolving workarounds including registry-based access to alternative BCG sources and continued use of durvalumab when BCG supply is disrupted. The panel agreed that even in these scenarios, BCG should not be deemphasized, and combination therapy should be preserved whenever possible. The session concluded with consensus that broad adoption will depend on education, infrastructure, and close collaboration across specialties.