Managing NMIBC-to-MIBC Transition After Prior IO Therapy

The expert faculty explore complex clinical scenarios involving patients who progress to muscle-invasive bladder cancer (MIBC) after receiving prior immunotherapy for high-risk 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 (e.g., less than six 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 IO exposure.