Two Onc Docs Urothelial ESMO 2025 Updates
Nov 10, 2025
This discussion dives into groundbreaking updates from the recent ESMO conference on bladder cancer. Key trials like POTOMAC reveal the benefits of adding immunotherapy to traditional treatments. The potential implications for cystectomy decisions are explored, particularly for non-muscle invasive bladder cancer. With significant advances in metastatic disease trials, the conversation highlights the importance of biomarker testing and innovative approaches, including ctDNA-guided therapy and promising new drug combinations.
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PD‑L1 + BCG Improves NMIBC Outcomes
- The POTOMAC trial showed dervalumab plus BCG improved disease-free survival in BCG‑naive high‑risk NMIBC with HR 0.68.
- This raises questions about which patients benefit most and whether cystectomy rates could fall.
Consider Perioperative EV + Pembrolizumab
- For cisplatin‑ineligible MIBC patients, consider EV plus pembrolizumab perioperatively based on KEYNOTE‑905 showing major EFS and OS benefits.
- Monitor for EV toxicities: skin, neuropathy, ocular issues, hyperglycemia, and GI effects.
ctDNA Enables Risk‑Adapted Adjuvant Therapy
- ctDNA (Signatera) guided adjuvant atezolizumab in IMvigor011 showed DFS benefit in ctDNA‑positive patients (HR 0.64) and OS signal (HR 0.59).
- This supports ctDNA as a promising tool for risk‑adapted perioperative therapy selection.