Oncology Brothers: Practice-Changing Cancer Discussions Challenging Cases in Non-Muscle Invasive Bladder Cancer (NMIBC) – Drs. Shilpa Gupta & Joshua Meeks
Nov 20, 2025
Dr. Joshua Meeks, a urologist at Northwestern University, and Dr. Shilpa Gupta, a medical oncologist at Cleveland Clinic, dive into the intricacies of managing non-muscle invasive bladder cancer (NMIBC). They explore the definition of high-risk NMIBC and discuss groundbreaking clinical trials like CREST and POTOMAC, focusing on immunotherapy innovations. The duo emphasizes the need for a collaborative approach between urologists and oncologists, addresses the challenges of side effects from treatment, and highlights patient-centered discussions in this rapidly evolving field.
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Defining High-Risk NMIBC
- High-grade, multifocal TA/T1 tumors define classic high-risk NMIBC patients needing prolonged therapy.
- Josh Meeks estimates ~76–78% three-year cancer-free rate with BCG and low (~1–2%) progression risk to muscle invasion.
Learning BCG-Unresponsive During Keynote-057
- Shilpa recalls screening for Keynote-057 and learning BCG-unresponsive definitions during that trial's conduct.
- She notes older trials (ALBIN) differed and that atezolizumab showed no benefit while CREST and POTOMAC did.
Consider IO + BCG For Selected Patients
- Consider adding checkpoint inhibitors to BCG for selected high-risk NMIBC to improve event-free survival based on CREST and POTOMAC data.
- Discuss duration differences: CREST used two years of IO while POTOMAC used one year when counseling patients.