Interpreting the POTOMAC Trial: Evaluating Durvalumab in BCG-Naïve NMIBC

The expert faculty review the phase 3 POTOMAC trial, presented at ESMO, which evaluated durvalumab combined with Bacillus Calmette–Guérin (BCG) in patients with high-risk, BCG-naïve non–muscle invasive bladder cancer (NMIBC). The study compared BCG induction plus maintenance with or without one year of durvalumab and demonstrated a 32% reduction in recurrence risk (HR = 0.68), with three-year disease-free survival rates of 82% for the durvalumab arm versus 77% for BCG alone. The panelists highlight that approximately 60% of patients had high-grade T1 disease, underscoring the aggressive nature of the population. While no progression or overall survival benefit was observed yet, experts emphasize the importance of reduced recurrence and the downstream benefits—fewer procedures, less treatment burden, and potential cystectomy delay. They agree that POTOMAC reinforces the role of checkpoint inhibitors in select patients, offering a meaningful step forward in improving bladder-sparing outcomes in NMIBC management.