GU Cancers 2026 | Selecting patients with high-risk NMIBC for BCG-immunotherapy strategies
Felix Guerrero-Ramos, MD, PhD, Hospital Universitario 12 de Octubre, Madrid, Spain, highlights the role of BCG induction plus maintenance in high-risk non-muscle invasive bladder cancer (NMIBC) despite the emergence of new trials, such as CREST (NCT04165317) and POTOMAC (NCT03528694), which show the benefit of adding systemic immune checkpoint inhibitors. The benefit of combining BCG with immune checkpoint inhibitors is small and carries an increased risk of adverse events, so clinicians need to be selective in choosing who will benefit most from this combination, particularly those at high risk. This interview took place at the 2026 ASCO GU Cancers Symposium in San Francisco, CA.
These works are owned by Magdalen Medical Publishing (MMP) and are protected by copyright laws and treaties around the world. All rights are reserved.
Transcript
Accurate work would not be totally against, but I believe that BCG induction plus maintenance has an important role and will still have an important role in the upcoming years. It is true that there are two new trials, the CREST and POTOMAC trials, which are positive and have shown that the addition of systemic immune checkpoint inhibitors increases the response rates as compared to BCG induction plus maintenance alone...
Accurate work would not be totally against, but I believe that BCG induction plus maintenance has an important role and will still have an important role in the upcoming years. It is true that there are two new trials, the CREST and POTOMAC trials, which are positive and have shown that the addition of systemic immune checkpoint inhibitors increases the response rates as compared to BCG induction plus maintenance alone. So that’s why BCG will still stay with us because there’s the need of BCG induction plus maintenance along with the immune checkpoint inhibitors. However, there is a very small magnitude of the benefit and an increased risk of adverse events. We have a number needed to treat of around three to five, and a number needed to harm of 15, 20 patients. So we should be able to select the patients who will benefit most from this combination. We know that the high-risk non-muscle invasive bladder cancer setting, as described in the trials, is very wide, is very heterogeneous and some patients like maybe those with a high grade Ta solitary tumor won’t benefit from this combination. So the challenge is really to identify those patients at a high risk and who will have more benefit from the combination of immune checkpoint inhibitors plus BCG.
This transcript is AI-generated. While we strive for accuracy, please verify this copy with the video.
Read more...
