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July 3, 2026Indian Journal of UrologyOpen Access

The immunotherapy paradox in high-risk non-muscle-invasive bladder cancer: A tale of three trials

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Authors

SAShashank AgrawalAsha HospitalAPAtanu PalAster MedcitySSSatyadeo SharmaAll India Institute of Medical Sciences Raipur

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Implication

Randomized trial evaluates immune checkpoint inhibitors with BCG in high-risk NMIBC, suggesting efficacy variations among treatments.

Key Points

  • To evaluate the efficacy of systemic immune checkpoint inhibitors combined with BCG therapy in high-risk NMIBC.
  • Three phase III trials (POTOMAC, CREST, ALBAN) assessed the addition of immune checkpoint inhibitors to BCG therapy.
  • POTOMAC trial added durvalumab; CREST trial added sasanlimab; ALBAN trial added atezolizumab.
  • Efficacy on event-free survival (EFS) and safety profiles were compared across trials.
  • POTOMAC showed HR 0.68 for EFS, with a 32% reduction in recurrence risk and higher grade 3/4 adverse events (21% vs. 4%).
  • CREST demonstrated HR 0.68 (P = 0.0095) with 91.7% complete response at 36 months in CIS.
  • ALBAN did not improve EFS (HR 0.98; P = 0.9106) and increased treatment-related adverse events.

Cite This Study

Agrawal et al. (2026) studied this question.

synapsesocial.com/papers/6a47545e5c29257aa257a06dhttps://doi.org/10.4103/iju.iju_98_26
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