Keypoints:
• Overview of the NIAGARA trial and its findings
• Comparison of Durvalumab and cisplatin-based chemotherapy outcomes
• The significance of event-free survival and overall survival rates
• Insights on managing side effects and treatment sequencing
• The evolving role of ctDNA in determining treatment strategies
In this episode of the Oncology Brothers podcast, we dived into the recent FDA approval of durvalumab in combination with chemotherapy for resectable muscle-invasive bladder cancer, based on the findings from the NIAGARA trial. We are joined by Dr. Thomas Powles, a GU medical oncologist and the lead author of the trial, who previously discussed the EV302 trial with us.
Dr. Powles explained how the NIAGARA trial represents a significant shift in our treatment approach, moving from traditional neoadjuvant chemotherapy with a cisplatin backbone to incorporating immunotherapy upfront, followed by surgery and adjuvant durvalumab. He shared insights into the study design, including the rationale for using four cycles of chemotherapy and the inclusion of patients with renal dysfunction.
We discuss the trial's primary endpoints, which showed a notable improvement in overall survival and event-free survival, as well as the implications of pathological complete response (pCR). Dr. Powles emphasized that while pCR is a valuable endpoint, it is not perfect, as some patients still relapse despite achieving it.
The conversation also touched on the safety of combining durvalumab with chemotherapy, with Dr. Powles stressed how the combination does not compromise surgical outcomes or increase adverse events. He highlighted the importance of managing side effects and prioritizing patient safety during treatment.
As we explore the future of immunotherapy in the adjuvant setting, we consider the role of ctDNA in determining which patients may benefit most from post-operative immunotherapy. Dr. Powles shared his thoughts on the evolving landscape of ctDNA research and its potential implications for treatment decisions.
Finally, we discussed the sequencing of therapies for patients who progress after receiving durvalumab and chemotherapy, weighed the options of using enfortumab with or without pembrolizumab.
Overall, this episode provided a comprehensive overview of the NIAGARA trial's findings and its impact on the standard of care for muscle-invasive bladder cancer, highlighting the promising advancements in treatment that can lead to improved patient outcomes.
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