#ESMO26 Dr. Michiel van der Heijden discussed the implications of VOLGA alongside KEYNOTE-905 and KEYNOTE-B15:

🔹 EV + durvalumab doublet: EFS HR 0.51; OS HR 0.58, a 42% reduction in the hazard of death.
🔹 Triplet (+ tremelimumab): EFS HR 0.61; OS not yet significant. More toxicity, without a demonstrated advantage from CTLA-4 blockade.
🔹 Crucial difference: VOLGA used only 3 neoadjuvant cycles of EV, followed by RC and adjuvant durvalumab, without adjuvant EV.
🔹 The unresolved question: Which patients need adjuvant therapy? pCR is informative, but does not guarantee eradication of micrometastatic disease.

🚨Key message: The doublet is the regimen most likely to move forward. The next breakthrough may come from response-adapted treatment, not adding another drug.
@UroToday @myESMO