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Opinion|Videos|November 13, 2025

Advancements in Perioperative Therapy for MIBC

Author(s)Thomas Powles, MD, Alan Tan, MD, Guru Sonpavde, MD

Experts discuss the promising results of the Niagara trial, highlighting benefits of cisplatin and durvalumab for unfit patients in cancer treatment.

Episodes in this series

5 panelists

EP. 1 Novel Neoadjuvant Therapies in MIBC

5 panelists

EP. 2 Advancements in Perioperative Therapy for MIBC

5 panelists

EP. 3 Analyzing the Role of ctDNA and Adjuvant Therapy

5 panelists

EP. 4 Biomarker, Diagnosis, and Evolving Treatment Paradigm in MIBC

5 panelists

EP. 5 Risk Stratification and Surveillance After

5 panelists

EP. 6 Unmet Needs and the Evolving Role of MRD Monitoring in MIBC

5 panelists

EP. 7 Integrating ctDNA-Based MRD Testing in MIBC

5 panelists

EP. 8 Improving Patient Communication and Treatment Decisions with ctDNA Monitoring in MIBC

5 panelists

EP. 9 Challenges in Standardizing ctDNA-guided MRD Testing in MIBC

5 panelists

EP. 10 Improving Workflow and ctDNA Adoption in MIBC Care

5 panelists

EP. 11 Advancing Multidisciplinary Collaboration in MIBC Management

5 panelists

EP. 12 Implementing ctDNA-Based MRD Testing in MIBC Clinical Practice

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.

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