Evaluating Atezolizumab in NMIBC: Understanding Negative Outcomes from the ALBAN Study

The expert faculty analyze the recently presented ALBAN trial, a phase 3 study evaluating atezolizumab in combination with intravesical BCG versus BCG alone for BCG-naïve, high-risk non–muscle invasive bladder cancer (NMIBC). They explain that the trial did not meet its primary endpoint of event-free survival, showing no significant difference between arms (HR = 0.98). Faculty note that while the study was well conducted, several design factors may have contributed to its negative outcome, including limited geographic enrollment, differences in BCG strain, absence of BCG reinduction, and the duration of both BCG and immunotherapy exposure. They also discuss potential distinctions between PD-L1 and PD-1 blockade mechanisms and how these could influence efficacy outcomes. Despite its negative result, the panel emphasizes the ALBAN trial’s importance in refining study design for future NMIBC research and understanding how strong BCG control-arm performance can influence trial interpretation and future therapeutic development.