Honoured to have had the opportunity to present "Optimal induction treatment in non-metastatic bladder cancer" at #ESMO26 in Madrid!

🚨 Does a deeper pathological response translate into greater survival benefit in perioperative MIBC?

An intriguing pattern across four phase III trials:
🔹 NIAGARA: ΔpCR +10 pp | EFS HR 0.68
🔹 KEYNOTE-B15: +23 pp | HR 0.53
🔹 VOLGA: +32 pp | HR 0.51
🔹 KEYNOTE-905: +49 pp | HR 0.40

Larger absolute pCR gains appear to track with greater EFS benefit.

But the comparator matters!

KEYNOTE-905 and VOLGA used surgery-based controls without neoadjuvant systemic therapy (control "pCR" ~8–9%), whereas NIAGARA and KEYNOTE-B15 used active neoadjuvant cisplatin-based chemotherapy.

Thus, the magnitude of ΔpCR is not directly comparable across trials.

The key question: Can pCR, combined with utDNA + ctDNA clearance, become a reliable tool for response-adapted treatment intensity?

⚠️ This is an exploratory, trial-level observation—not proof that pCR improvements cause EFS benefits or that pCR is a validated surrogate endpoint!

Better biomarkers could help us maximize cure while minimizing overtreatment. 🔬

#ESMO26 #BladderCancer

@weoncologists @urotoday @Uromigos

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