Identifying Ideal Candidates for Immunotherapy Combinations in High-Risk NMIBC

The expert faculty explore how to select appropriate patients for future use of systemic immunotherapy combined with BCG in high-risk non–muscle invasive bladder cancer (NMIBC), assuming approval of durvalumab or sasanlimab. They emphasize that patient selection requires balancing benefit against risks such as immune-related adverse events, treatment burden, and healthcare logistics. The panelists note that while the absolute event-free survival gains from trials like POTOMAC and CREST were modest (5–7%), the results were clinically meaningful in specific high-risk subgroups. They agree that patients with T1 disease, particularly those with concurrent carcinoma in situ (CIS) or features that might otherwise prompt consideration of cystectomy, may derive the most benefit from combination therapy. The discussion also underscores the importance of assessing patient motivation, compliance, and ability to promptly report immune-related toxicities to ensure safe, effective treatment within a multidisciplinary framework.