New hope for tough bladder cancer: immune drug plus chemo combo enters trial

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: 1. Age ≥18 years; sex: all; signed written informed consent by the participant or legally authorised representative. 2. Histologically confirmed high-risk non-muscle-invasive bladder cancer (HR-NMIBC), defined as any T1, high-grade Ta, and/or carcinoma in situ (CIS). 3. BCG-intolerant (unable to continue BCG because of severe adverse reactions) or meeting at least one definition of BCG treatment failure: 1. Persistent or recurrent CIS within 12 months after completion of adequate BCG (with or without concomitant NMIBC); 2. Recurrent high-grade Ta/T1 within 6 months after completion of adequate BCG; 3. High-grade T1 at the first evaluation after BCG induction (\~3 months); 4. Ta high-grade and/or CIS present or recurrent at \~3 months after receiving ≥5 BCG instillations. Adequate BCG, for the purposes of this protocol, is defined as receipt of at least 5 of 6 induction instillations (maintenance not required). 4. ECOG performance status 0-2. 5. Adequate organ function per protocol laboratory criteria. 6. No intravesical chemotherapy or immunotherapy between the most recent cystoscopy/TURBT and study start; a single immediate postoperative intravesical chemotherapy at the time of the most recent cystoscopy/TURBT is allowed during screening per local practice. 7. Willing and able to comply with study procedures. Exclusion Criteria: 1. Muscle-invasive bladder cancer (T2-T4). 2. Low-grade (LG) recurrence during or after BCG therapy. 3. Concomitant upper tract urothelial carcinoma, or lymph-node/distant metastasis. 4. Indwelling ureteral stent or known vesicoureteral reflux. 5. Contraindications to intravesical instillation, including within 2 weeks after TURBT, bladder perforation, symptomatic urinary tract infection, or gross haematuria. 6. Known hypersensitivity or contraindication to gemcitabine, mitomycin C, or toripalimab. 7. Systemic chemotherapy, small-molecule targeted therapy, or radiotherapy within 2 weeks before first study treatment. 8. Prior immune checkpoint inhibitor therapy. 9. Pregnant, planning pregnancy, or breastfeeding women. 10. Ongoing acute or chronic systemic infection, or history of active tuberculosis. 11. Other malignancy requiring active treatment. 12. Any condition that, in the investigator's judgment, makes participation not in the patient's best interest or could confound study results. Study Population Adults with BCG-unresponsive or BCG-intolerant HR-NMIBC treated at participating centres in China.