To be clear, here is the rest of what the article title should be...

> ...for individuals with high-risk non-muscle-invasive bladder cancer whose cancer had previously resisted treatment

This is relatively common with experimental therapies in trials, and thus shouldn't be interpreted as the final say on its usage.

Part of the reason why is that it's difficult to convince patients or providers to reach for the experimental treatment in trial before the current standard of care. Many first-line treatments began as second/third-line or salvage treatments before experiencing line promotion or (if surgery is involved) neoadjuvant promotion. Keytruda is a good example of this progression in action.

Only those patients were admitted to the trial, so the effectiveness of the treatment on later-stage muscle-invasive disease is unknown. That it's scoped to patients who are BCG-unresponsive ("previously resisted treatment") makes the breakthrough more significant, not less.