Oncology Brothers: Practice-Changing Cancer Discussions Perioperative Durvalumab FDA Approval New Standard for Muscle Invasive Bladder Cancer
May 5, 2025
Dr. Thomas Powles, a GU medical oncologist from Barthes Cancer Institute and lead author of the NIAGARA trial, discusses the groundbreaking FDA approval of Durvalumab for muscle-invasive bladder cancer. The conversation delves into the trial's design, showcasing its promising survival rates compared to traditional treatments. Dr. Powles emphasizes the importance of immunotherapy in perioperative settings and the role of ctDNA in tailoring treatment strategies. Listeners gain insights into managing side effects and the evolving landscape of cancer care.
AI Snips
Chapters
Transcript
Episode notes
Niagara Trial Design Highlights
- Four cycles of cisplatin-based gemcitabine chemotherapy is the widely accepted neoadjuvant standard in muscle-invasive bladder cancer.
- The Niagara trial added perioperative durvalumab (before and after surgery) to improve survival outcomes significantly.
Durvalumab Improves Survival Outcomes
- Adding durvalumab to chemotherapy yields a 25% reduction in risk of death and 7% higher two-year overall survival.
- Pathologic complete response is helpful but imperfect; even with it, some patients relapse, showing immunotherapy benefits beyond pCR.
Manage Immune Toxicity Pragmatically
- Avoid giving additional immune therapy cycles if serious immune-related toxicity develops before surgery.
- Prioritize getting patients safely to surgery over pushing through treatment-related side effects.