#ESMO26 Can molecular profiling identify who benefits most from perioperative durvalumab in MIBC?
Exploratory genomic/transcriptomic analyses from NIAGARA.
🔹 TP53alt in 50% of tumors, co-occurred with RB1, while mutually exclusive with FGFR3.
🔹ERCC2-mutated tumors achieved 75% pCR across treatment arms.
🔹 EFS benefit: TMB-high HR 0.44; TP53-mutated HR 0.51; FGFR3-mutated HR 0.24.
🔹 Immune-enriched subtypes: Basal-squamous HR 0.47; luminal-infiltrated HR 0.67.
🔹 Higher T-effector infiltration and IFNγ signaling were associated with greater benefit.
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