Advancements in Perioperative Therapy for MIBC

In this segment, Dr. Thomas Powles led a discussion on the evolving perioperative treatment landscape for muscle-invasive bladder cancer (MIBC), focusing on the NIAGARA and EV-303 (enfortumab vedotin plus pembrolizumab (EV Pembro)) trials. Panelists highlighted the NIAGARA trial’s inclusion of patients with reduced renal function who received split-dose cisplatin with durvalumab, demonstrating meaningful clinical benefit and high pathologic complete response rates. They emphasized that the regimen provides an effective and feasible option even for select “cisplatin-unfit” patients. Then the panelists discussed the EV-303 trial, noting the 57% pathologic complete response with EV Pembro, including in a subset of cisplatin-eligible patients who declined chemotherapy. While cross-trial comparisons suggest encouraging efficacy, the panelists cautioned that additional phase 3 data are needed to define the optimal role of EV Pembro relative to gemcitabine/cisplatin plus immunotherapy combinations in the perioperative setting.