The Pursuit of Intravesical and Systemic Therapies in Non–muscle-invasive Bladder Cancer: Challenges and Opportunities

In this issue of European Urology Oncology, Inman et al. [ [1] Inman BA, Hahn NM, Stratton K, et al. A phase 1b/2 study of atezolizumab with or without bacille Calmette-Guérin in patients with high-risk non–muscle-invasive bladder cancer. Eur Urol Oncol. In press. https://doi.org/10.1016/j.euo.2023.01.013. Google Scholar ] report results from a phase 1b/2 trial investigating the anti-PD-L1 checkpoint inhibitor (CPI) atezolizumab with and without intravesical bacille Calmette-Guérin (BCG) for patients with BCG-unresponsive high-risk non–muscle-invasive bladder cancer (NMIBC). This small trial of 24 patients (n = 12 in each cohort) showed modest activity, with 6-mo complete response (CR, not counting low-grade recurrence) rates of 33% and 42%without and with BCG, respectively. The median duration of response (DOR) was 6.8 mo without BCG and not reached for the BCG group. All patients experienced an adverse event (AE), but only few were severe and the therapy was largely well tolerated; the combination of intravesical BCG and intravenous anti-PD-L1 therapy was feasible.