Key Findings from the CREST Trial and Implications for BCG-Naïve NMIBC

The expert faculty review the pivotal phase 3 CREST trial, which evaluated subcutaneous sasanlimab in combination with Bacillus Calmette–Guérin (BCG) for BCG-naïve, high-risk non–muscle invasive bladder cancer (NMIBC). The study enrolled more than 1,000 patients across three arms—BCG alone, BCG plus sasanlimab with induction only, and BCG plus sasanlimab with maintenance for up to two years. The results demonstrated a significant 32% reduction in the risk of event-free survival (EFS) events (HR = 0.68), establishing the benefit of adding immunotherapy to standard BCG. The panelists noted that these data suggest immune checkpoint inhibitors can help overcome BCG resistance by preventing immune escape. They also highlighted important nuances, such as the low carcinoma in situ (CIS) representation in this study and the biological rationale linking BCG-induced PD-L1 upregulation to enhanced checkpoint inhibitor efficacy. Overall, the faculty agreed that CREST represents a potential practice-changing advancement