Two Onc Docs, hosted by Samantha A. Armstrong, MD, and Karine Tawagi, MD, is a podcast dedicated to providing current and future oncologists and hematologists with the knowledge they need to ace their boards and deliver quality patient care. Dr Armstrong is a hematologist/oncologist and assistant professor of clinical medicine at Indiana University Health in Indianapolis. Dr Tawagi is a hematologist/oncologist and assistant professor of clinical medicine at the University of Illinois in Chicago.

In this episode, OncLive On Air® partnered with Two Onc Docs to review exciting updates from the 2025 ESMO Congress about bladder cancer management that have the potential to change guidelines. In non–muscle-invasive bladder cancer (NMIBC), 2 trials added immunotherapy to BCG. The phase 3 POTOMAC trial (NCT03528694) combining durvalumab (Imfinzi) with BCG for high-risk, BCG-naive NMIBC was positive, demonstrating improved disease-free survival with the combination. This regimen might become a new standard of care and could reduce the need for early radical cystectomy, the experts highlighted.

For muscle-invasive bladder cancer, the phase 3 KEYNOTE-905 study (NCT03924895) combined perioperative enfortumab vedotin-ejfv (Padcev) and pembrolizumab (Keytruda) for cisplatin-ineligible patients. This positive trial demonstrated strong event-free survival and overall survival (OS) with the combination. Furthermore, the phase 3 IMvigor011 trial (NCT04660344) provided data on a risk-adapted approach using adjuvant atezolizumab (Tecentriq) for post-cystectomy patients with circulating tumor DNA (ctDNA)–positive disease. For these patients, atezolizumab generated benefits in disease-free survival and OS, supporting the future use of ctDNA for personalized therapy.

Updates in metastatic bladder cancer emphasized the importance of testing for FGFR alterations and HER2 expression in the second-line setting, Armstrong and Tawagi explained. The phase 1 FORAGER-1 study (NCT05614739) showed the efficacy of an oral FGFR3 inhibitor in heavily pretreated patients and showed lower rates of hypophosphatemia with the agent compared with erdafitinib (Balversa). Overall, the conference yielded many new and exciting data points for the treatment of patients with bladder cancer.