Perioperative Research Success Is Set to Transform Bladder Cancer Care After ESMO 2026

In this episode of Oncology Unplugged, host Chandler Park, MD, MSc, FACP, a medical oncologist at Norton Cancer Institute in Louisville, Kentucky, was joined by Petros Grivas, MD, PhD, FASCO, the medical director of local/regional outreach and international program and a professor in the Clinical Research Division at Fred Hutch Cancer Center, as well as a professor in the Division of Hematology and Oncology at the University of Washington School of Medicine in Seattle.

Their discussion centered on key bladder cancer data presented at the 2026 ESMO Congress, highlighting the rapidly expanding landscape of perioperative, metastatic, and non–muscle-invasive disease management. Drs Park and Grivas first addressed findings from the phase 3 VOLGA trial (NCT04960709), which evaluated neoadjuvant durvalumab (Imfinzi) plus enfortumab vedotin-ejfv (Padcev), with or without tremelimumab (Imjudo), followed by cystectomy and adjuvant durvalumab in patients with cisplatin-ineligible or cisplatin-declining muscle-invasive bladder cancer. Dr Grivas noted that the durvalumab/enfortumab vedotin arm met both event-free survival (EFS) and overall survival (OS) end points, whereas the tremelimumab arm met the end point for EFS but not OS. He emphasized that the need for adjuvant enfortumab vedotin remains an open question.

The conversation then turned to the discordant results among trials in cisplatin-eligible patients. Dr Grivas contrasted the positive phase 3 NIAGARA trial (NCT03732677) data with the results of the phase 3 KEYNOTE-866 (NCT03924856) and ENERGIZE (NCT03661320) trials, which did not meet their EFS end points, and noted that all 3 enfortumab vedotin–based perioperative trials were positive. They also discussed exploratory circulating tumor DNA analyses from VOLGA and the phase 3 KEYNOTE-B15 study (NCT04700124), molecular subtype analysis findings from NIAGARA, and ongoing bladder-preservation trials.

Drs Park and Grivas also reviewed data in metastatic disease, including from cohort 7 of the phase 2 TROPHY-U-01 trial (NCT03547973), in which sacituzumab govitecan-hziy (Trodelvy) plus enfortumab vedotin and zimberelimab (AB122/GLS-010) yielded a high overall response rate. They also discussed data with sacituzumab tirumotecan (MK-2870/SKB264) plus pembrolizumab (Keytruda). In non–muscle-invasive disease, Dr Grivas discussed data from the phase 3 POTOMAC trial (NCT03528694) of durvalumab plus BCG and the role of shared decision-making in bladder cancer management. The experts concluded by highlighting developments in artificial intelligence, as well as the importance of patient advocacy and clinical trial participation.