LUGPA 2025 CME Enduring Program: Operationalizing the Science -Translating New Concepts into Clinical Practice-2025 CME Program Part 3

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Video Summary

Dr. Suzanne Merrill, a urologic oncologist, reviewed recent immunotherapy advances in bladder cancer. Bladder tumors evade immune attack via PD-L1 proteins that suppress T-cell activity, but immune checkpoint inhibitors (ICIs) like PD-1/PD-L1 blockers release these brakes, enabling immune response. Two major phase 3 trials in BCG-naive, high-risk non-muscle invasive bladder cancer—CREST (using PD-1 blocker sesansolamab) and Potomac (PD-L1 inhibitor diverlamab)—showed about 32% reduction in recurrence risk when combined with BCG, with no improvement in overall survival, likely due to highly effective BCG maintenance regimens. Toxicities differed between drugs. A third trial, Albin, was negative, possibly due to differences in BCG dosing and patient risk. In muscle-invasive bladder cancer, perioperative diverlamab reduced recurrence and death risk, while a recent trial combining enfortumab vedotin with pembrolizumab showed a 60% event-free survival and 50% overall survival benefit in cisplatin-eligible patients, establishing new standards. These advances highlight the growing integration of ICIs earlier in bladder cancer treatment.

Keywords

bladder cancer

immunotherapy

immune checkpoint inhibitors

PD-1/PD-L1 blockers

BCG maintenance