Mashukur Rahman, Clinical Oncology Resident, Physician, FCPS (Internal Medicine) (Final Part), BCS Health Cadre, Committed to Cancer Research, Patient Care, learning Oncology shared a post on LinkedIn:
“The “Chemo-First” Era Is Over in Bladder Cancer
For 30 years, platinum chemotherapy was untouchable.
That era just ended.
What changed?
- NCCN now recommends:
Enfortumab_Vedotin + Pembrolizumab as a Category 1 preferred 1st-line treatment for metastatic/advanced urothelial carcinoma.
- Based on EV-302, this applies regardless of cisplatin eligibility.
Why it matters?
- EV-302 showed near-doubling of overall survival versus chemotherapy.
- Higher response rates.
- Earlier access to effective therapy.
Who it affects?
- Newly diagnosed locally advanced or metastatic urothelial carcinoma.
- Both cisplatin-eligible and ineligible patients.
What else is new?
• Perioperative “sandwich” therapy in muscle-invasive disease.
NIAGARA regimen:
- Neoadjuvant chemotherapy + Durvalumab
- Followed by adjuvant Durvalumab after surgery.
What I’ll do differently in practice-
- Start first-line discussions with EV + Pembrolizumab, not Gem-Cis.
- Reframe chemotherapy as a partner, not the backbone.
- Think ADC + IO early, not as salvage.
Then: Chemo first
Now: ADC + Immunotherapy first.”
More posts featuring Mashukur Rahman on OncoDaily.