🚨⭐ #ESMO26 | GU ONCOLOGY — DAY 2 HIGHLIGHTS

A major day for bladder and prostate cancer: practice-relevant phase III data, longer survival follow-up and new molecular clues.

🟠 VOLGA | LBA2 — A pivotal MIBC result

In cisplatin-ineligible/refusing MIBC, perioperative durvalumab + neoadjuvant enfortumab vedotin vs radical cystectomy ± approved adjuvant therapy:

✅ 2-year EFS: 64% vs 45% | HR 0.51
✅ 2-year OS: 78% vs 69% | HR 0.58

A meaningful survival signal, but not a head-to-head comparison with EV + pembrolizumab.

🔵 DASL-HiCaP | LBA4 — Intensification with radiotherapy

Darolutamide + ADT + RT improved 4-year metastasis-free survival to 95% vs 88% (HR 0.42) in very-high-risk prostate cancer.

OS remains immature; this use is investigational.

🔵 PEACE-1 | 2215O — Durability matters

After 7.7 years' follow-up in de novo mCSPC, ADT + docetaxel + abiraterone delivered median OS of 6.2 vs 4.4 years (HR 0.68).

Eight-year OS: 40.3% vs 27.1%.

🔵 PROTEUS substudy | LBA53

Perioperative apalutamide + ADT around prostatectomy vs surgery alone in high-risk localised disease:

✅ EFS HR 0.38 (n=408).

Promising but setting-specific evidence; longer follow-up matters.

🧬 STAMPEDE / Decipher | 2045O

Genomic risk may help identify patients deriving greater benefit from abiraterone for distant-metastasis prevention.

Retrospective biomarker evidence—not yet a mandate to de-escalate.

🟠 NIAGARA molecular analysis | 4741RO

Exploratory EFS signals across several molecular subtypes, including basal-squamous disease.

No validated biomarker yet to withhold perioperative durvalumab.

🟠 EV-103 | 4740RO

Long-term EV + pembrolizumab follow-up in advanced urothelial cancer:

✅ Estimated 5-year OS: 33% in pooled cohorts.

Durability and late toxicity both matter.

🟠 GDFATHER-NEO | 4757RO

Visugromab + nivolumab:
✅ pCR 33.3% vs 7.7% with nivolumab + placebo.

Exciting but exploratory (n=28 evaluable).

⭐ MY CLINICAL PEARL

Not every form of intensification is equal.

What matters is proven survival or metastasis prevention, alongside toxicity, patient selection and quality of life.

Precision AND durable benefit—not just higher response rates.

@gbanna74 @ravikanesvaran @nataliagandur @neerajaiims @Sebastiano_Buti @CinziaConted @dralishadamani @amg120395 @PGrivasMDPhD @koshkin85 @MicheleMaffezz @ParamMariappan @dmukherji @VanitaNoronha @montypa @DanieleRaggi83 @PasRescigno @jteoh_hk @alison_tree @DrYukselUrun @yekeduz_emre @AgrawalTrush @AndrewKevinAlo1

#ESMO26 #GUOncology #BladderCancer #ProstateCancer #MIBC #mCSPC #PrecisionOncology