Durvalumab + BCG in BCG-naive high-risk NMIBC

Durvalumab given systemically alongside intravesical BCG in BCG-naive high-risk non-muscle-invasive bladder cancer is a combination pairing that reduced recurrence at the cost of systemic side effects in a disease usually treated locally. The rationale is that BCG primes a local Th1 immune response in the bladder, and PD-L1 blockade prevents that response from becoming exhausted while potentially reaching micrometastatic disease. The phase 3 POTOMAC trial was positive for disease-free survival and led to approval in May 2026. The result is not automatically a class effect, because ALBAN, which tested atezolizumab plus BCG, was negative, while CREST, which tested sasanlimab plus BCG, was positive.