The CREST and Potomac trials showed adding immunotherapy to standard BCG treatment improves event-free survival by only ~5% at 24 months. This modest gain comes with a five-fold increase in significant adverse events, creating a crucial risk-reward discussion for patients.
The TAR-200 gemcitabine delivery device achieved an 82.4% complete response rate, the highest to date in this space. Critically, this was accomplished without allowing patients a second chance (re-induction) after recurrence, a common practice in other trials, suggesting its efficacy is exceptionally robust.
An oral FGFR inhibitor (ARDA) showed strong efficacy but was halted due to severe systemic toxicities. This "failure" successfully provided proof of concept for the drug's mechanism, strategically redirecting research toward local, in-bladder delivery to maintain efficacy while minimizing side effects.
A positive circulating tumor DNA (ctDNA) test in a patient with a known bladder tumor can be misinterpreted as metastatic disease. However, the local tumor itself sheds DNA. Resecting this tumor can clear the ctDNA signal, a critical nuance to prevent misdiagnosis and premature, aggressive systemic therapy.
A trial adding mitomycin to spare BCG failed its primary endpoint of improving survival. However, since it wasn't inferior, it serves as a viable fallback. A subgroup analysis showed a slight benefit in high-risk T1/CIS patients, positioning it as a targeted strategy when BCG supplies are limited.