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Highlights from the 2025 American Society of Clinical Oncology Annual Meeting |
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Advancing Perioperative Treatment Options for Localized Muscle-Invasive Bladder Cancer: A Step Forward
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| Integration of Universal Perioperative Immunotherapy
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| Maria Jose Ribal, MD, PhD
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| Maria Jose Ribal advocated for a universal perioperative immunotherapy approach in MIBC, combining immunotherapy before and after surgery to maximize curative potential and offset the lack of reliable biomarkers for patient selection. Data from trials like NIAGARA showed improved event-free and overall survival with this strategy, though questions remain about overtreatment, toxicity, and the independent value of adjuvant therapy.
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| Risk-Adaptive Neoadjuvant Chemotherapy and Adjuvant Immunotherapy
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| Jonathan Rosenberg, MD
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| Jonathan Rosenberg highlighted a shift toward a "sandwich" approach using both neoadjuvant chemotherapy and adjuvant immunotherapy (e.g., durvalumab), supported by the NIAGARA trial showing improved survival outcomes. He emphasized the need for better risk stratification—particularly with biomarkers like ctDNA and PD-L1—to guide treatment decisions and avoid overtreatment, though these markers are not yet fully validated for clinical use.
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| Navigating the Crossroads: Evolving Paradigms in Perioperative Management of Muscle-Invasive Bladder Cancer |
| Anne Schuckman, MD, FACS |
| Anne Schuckman highlighted the increasingly complex and personalized perioperative management of MIBC, emphasizing the evolving role of biomarkers, chemotherapy, immunotherapy, and bladder-sparing strategies like trimodal therapy (TMT). She discussed ongoing efforts to optimize patient selection for neoadjuvant and adjuvant therapies, including the use of ctDNA and PD-L1 status, while raising critical concerns about overtreatment and toxicity. |
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Oral Abstract Session: Genitourinary Cancer— Bladder
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| Exploratory Analysis of Responders from the Phase 3 EV-302 Trial of Enfortumab Vedotin + Pembrolizumab Versus Chemotherapy in Previously Untreated Locally Advanced or Metastatic Urothelial Carcinoma
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| Shilpa Gupta, MD
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| Shilpa Gupta presented an exploratory analysis from the phase 3 EV-302 trial, showing that enfortumab vedotin + pembrolizumab nearly doubled the confirmed complete response rate compared to chemotherapy in previously untreated metastatic urothelial carcinoma. Patients with complete responses to the combination therapy experienced longer progression-free survival and a trend toward improved overall survival, reinforcing this regimen as the first-line standard of care.
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| Circulating Tumor DNA in Patients with MIBC Who Received Perioperative Durvalumab in NIAGARA |
| Thomas Powles, MBBS, MRCP, MD |
| Thomas Powles presented an exploratory analysis from the phase 3 NIAGARA trial showing that perioperative durvalumab improved ctDNA clearance and was associated with better clinical outcomes in patients with muscle invasive bladder cancer. ctDNA+ status before surgery was linked to non-pathological complete response, and durvalumab provided event-free and disease-free survival benefits regardless of ctDNA status, reinforcing its role in perioperative treatment. |
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| Mitomycin + BCG as Adjuvant Intravesical Therapy for High-Risk Non–muscle-Invasive Bladder Cancer: A Randomized Phase 3 Trial (ANZUP 1301) |
| Dickon Hayne, MD, FRCS |
| Dickon Hayne presented results from the ANZUP 1301 phase 3 trial, which evaluated intravesical BCG plus mitomycin versus BCG alone in high-risk, BCG-naïve non–muscle-invasive bladder cancer. The study showed similar 2-year disease-free survival and safety profiles between the two arms, with a potential benefit in higher-risk subgroups. Importantly, the combination required fewer BCG doses and had higher treatment adherence, making it a promising alternative amid global BCG shortages. |
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