Kudos @tompowles1 on a fantastic #VOLGA presidential @ #ESMO26 👏

Less is More!
• Cis-inelig MIBC, 25% were cis refusers
• D+EV x3 → RC → adj D x9 (NO adj EV)
• EFS HR 0.51 
• OS HR 0.58 
• pCR 45 vs 10%
• G3-4 TRAE 30%, 
• neuropathy only 18% 
• imAEs 33% (G3-4 11%)
• GHS/QoL maintained post-RC
• Treme ↑tox (G3-4 42%, 5 deaths), NO OS gain.

My take: it's not just about chasing bigger numbers. Tox matters too, especially when OS is achieved. Need to discuss the pros and cons with patients.
Less PN and skin tox, and fewer G3+ immune AEs than more cycles and that's a win for patients ! 🙌

@Uromigos @OncoAlert @brian_rini @LosUromigos @drenriquegrande