Kristen Scarpato, MD, on combination strategies in BCG-naïve NMIBC

Several trials in the BCG-naïve non–muscle invasive bladder cancer (NMIBC) setting are exploring the combination of BCG with immune checkpoint inhibitors, including POTOMAC (durvalumab [Imfinzi]) CREST (sasanlimab), and ALBAN (atezolizumab [Tecentriq]).

CREST demonstrated that the addition of sasanlimab to BCG significantly improved event-free survival vs BCG alone (HR, 0.68; 95% CI, 0.49 to 0.94, 1-sided P = .0095).¹ Similarly, POTOMAC reported that durvalumab plus BCG improved disease-free survival vs BCG alone (HR, 0.68; P = .0154).² However, ALBAN did not show a significant difference in EFS between atezolizumab plus BCG vs BCG monotherapy (HR, 0.98; 95% CI, 0.71 to 1.36; P = .9106).³

In the following interview, Kristen R. Scarpato, MD, MPH, discusses what level of evidence is truly needed to move beyond BCG alone. Scarpato is an associate professor of urology at Vanderbilt University Medical Center in Nashville, Tennessee.

REFERENCES

1. Shore ND, Powles T, Bedke J, et al. Sasanlimab in combination with Bacillus Calmette-Guérin improves event-free survival versus Bacillus Calmette Guérin as standard of care in high-risk non-muscle invasive bladder cancer: Phase 3 CREST study results. J Urol. 2025;213(5S)

2. De Santis M, Palou J, Nishiyama H, et al. Durvalumab (D) in combination with Bacillus Calmette-Guérin (BCG) for BCG-naïve, high-risk non-muscle-invasive bladder cancer (NMIBC): Final analysis of the phase III, open-label, randomised POTOMAC trial. Presented at: European Society for Medical Oncology Congress. October 17-21, 2025. Berlin, Germany. Abstract LBA108. https://s3.eu-central-1.amazonaws.com/m-anage.com.storage.esmo/static/esmo2025_abstracts/LBA108.html.pdf

3. Roupret M, Bertaut A, Pignot G, et al. ALBAN: A phase III, randomized, open-label international study of intravenous (iv) atezolizumab and intravesical Bacillus Calmette-Guérin (BCG) vs BCG alone in BCG-naïve high-risk, non-muscle-invasive bladder cancer (NMIBC). Presented at: 2025 European Society for Medical Oncology Congress. October 17-21, 2025. Berlin, Germany. LBA110. https://s3.eu-central-1.amazonaws.com/m-anage.com.storage.esmo/static/esmo2025_abstracts/LBA107.html.pdf