Managing NMIBC-to-MIBC Transition After Prior IO Therapy

The members of the expert faculty explore complex clinical scenarios involving patients who progress to muscle-invasive bladder cancer (MIBC) after receiving prior immunotherapy for high-risk non–muscle invasive bladder cancer (NMIBC). They discuss how future cases may require individualized decision-making once agents such as durvalumab or sasanlimab become integrated into NMIBC treatment paradigms. Panelists emphasize evaluating prior immunotherapy tolerance, time since last exposure, and treatment response to guide whether a patient should be considered for rechallenge with checkpoint inhibitors in the perioperative or metastatic setting. They note that shorter intervals between therapies (eg, less than 6 months) may warrant caution, while longer intervals could support reintroduction. The discussion highlights ongoing research into immunotherapy rechallenge strategies, including studies assessing re-exposure efficacy and safety. Faculty underscore the importance of multidisciplinary collaboration and evolving data to refine management for patients transitioning from NMIBC to MIBC following prior systemic immuno-oncology (IO) exposure.