Bringing POTOMAC Data Into Community Urology Practice for High-Risk NMIBC

In the final installment in this series, Neal D. Shore, MD, FACS, asks Chandler Park, MD, who works closely with the 40-plus-physician First Urology group in Louisville, what advice he would offer other large urology practices ready to act on the phase 3 POTOMAC (NCT03528694) data. Park lays out a practical framework any practice can implement: Take a family history of autoimmune disease, endocrinopathies, bowel issues, and prior transplants; check baseline labs, including thyroid function, before starting therapy; monitor on the same 28-day cadence as durvalumab (Imfinzi) dosing; and follow a simple algorithm, starting Synthroid once TSH climbs above 10 rather than waiting months for an endocrinology referral. He recommends clinicians conduct symptom-directed assessments at every visit, covering pulmonary symptoms, bowel habits, kidney function, and rash grading, and suggests the field could benefit from a shared American Urological Association (AUA)-style immunotherapy guideline.

Shore agrees, pointing to the growing library of educational resources available through the AUA, the American Society of Clinical Oncology, and trial sponsors that can help urologists get comfortable offering the therapy. He then delivers a quick recap of the POTOMAC findings: fewer early high-risk disease events, delayed time to high-risk events, fewer BCG-unresponsive recurrences, a delay in time to cystectomy, a favorable cystectomy-free survival trend, and a disease-free survival benefit across the papillary subgroups, the largest population studied in POTOMAC.

Asked for closing thoughts, Park calls the May 2026 approval of durvalumab plus BCG a win for both patients and urologists, comparing the learning curve ahead to the early days of enfortumab vedotin-ejfv (Padcev), when oncologists were hesitant but soon grew comfortable managing it. Shore agrees that optimizing individualized patient care is the north star, acknowledging not every patient is a candidate, but for those wanting their best shot, upfront patient and caregiver education can support bladder-sparing outcomes and help avoid the cascade of BCG-unresponsive therapies.