Expert weighs the potential role for BCG/ICI combinations in NMIBC

In the following video, Song Jiang, MD, PhD, discusses how emerging data on BCG and immune checkpoint inhibitor combinations in BCG-naive NMIBC are shaping expectations around efficacy, toxicity, and future treatment decision-making. Jiang is a clinical assistant professor of urology at Northwestern Medicine in Chicago, Illinois.

As studies of BCG/ICI combinations continue to mature in BCG-naive non–muscle-invasive bladder cancer (NMIBC), Jiang highlighted event-free survival—particularly reductions in high-grade recurrence—as one of the most encouraging early signals. He noted that while these outcomes are clinically meaningful, the field is still awaiting more definitive evidence of improvement in cystectomy-free survival, which more directly reflects the goal of bladder preservation. In addition to efficacy, he emphasized the importance of maintaining a functional bladder and carefully evaluating treatment-related toxicity.

Jiang pointed out that immune-related adverse events remain a notable concern with these combination approaches, with some trials reporting relatively high rates of grade 3 toxicities. As such, understanding how to mitigate and manage these adverse effects will be critical in interpreting the overall benefit-risk profile of these regimens. He suggested that toxicity considerations may ultimately influence how broadly these therapies are adopted in clinical practice.

Looking ahead, Jiang explained that if long-term benefits are confirmed, BCG/ICI combinations could meaningfully impact treatment strategies, particularly for high-risk patients such as those with multifocal disease, carcinoma in situ, or lymphovascular invasion. However, he underscored that treatment decisions will require a nuanced, individualized approach, balancing improvements in event-free survival against the potential for significant toxicity, with shared decision-making between physicians and patients playing a central role.