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Matthew Kurian: 3 Major Trials Are Reshaping How We Treat MIBC

Matthew Kurian/youtube.com

Aug 22, 2025, 05:17

Matthew Kurian: 3 Major Trials Are Reshaping How We Treat MIBC

Matthew Kurian, Assistant Professor of Medicine at the University of Kentucky College of Medicine, shared a post on LinkedIn about a paper by Sabrina Serani published on Targeted Oncology:

“Exciting Progress in Muscle Invasive Bladder Cancer (MIBC): ctDNA-Guided Atezolizumab, Perioperative Chemo-IO, and EV + Pembro

Three major trials are reshaping how we treat MIBC:

1. IMvigor011 – ctDNA-guided adjuvant atezo, Natera + Roche/Genentech

MRD+ (Signatera) → significant DFS and OS benefit with adjuvant atezolizumab
MRD– → excellent outcomes with surveillance (12-mo OS 100%, 18-mo OS 98%) and further details in press release with more info coming soon!
Elevates ctDNA as a decision-making tool in resected MIBC.
Schedule: Adjuvant atezo every 3 weeks × 1 year

2. NIAGARA – durva + cisplatin chemo (periop, AstraZeneca)

EFS benefit (HR ~0.68, p<.0001)
pCR ~37% vs 27% with chemo alone
Better metastasis-free & disease-specific survival
FDA-approved for cisplatin-eligible patients.
Schedule: 4 cycles cisplatin/gemcitabine + durvalumab → cystectomy → durvalumab maintenance × 1 year

3. KEYNOTE-905 / EV-303 – EV + pembro (cisplatin-ineligible)

Neoadjuvant + adjuvant EV + pembro improved EFS, OS, and pCR vs surgery alone in press release and more info at upcoming meeting!
First systemic regimen to beat surgery alone in this population.
Schedule: 3 cycles neoadjuvant EV (days 1 & 8) + pembro (day 1, q3w) → cystectomy → up to 6 cycles adjuvant EV + pembro
Safety profile consistent with what we have seen prior with combo.

The key questions now:

Does IMvigor011 still apply in the era of neoadjuvant chemo-immunotherapy?
For patients going straight to cystectomy, who should still get adjuvant IO?
How will EV + pembro (KEYNOTE-905) stack up against NIAGARA in cisplatin-eligible disease?

We’re moving from “one-size-fits-all” to biomarker- and regimen-tailored therapy in MIBC.”

Title: Neoadjuvant Pembrolizumab and Enfortumab Vedotin Improve Outcomes in MIBC

Author: Sabrina Serani

The full article here.

Matthew Kurian