How do you interpret NIAGARA efficacy given that adjuvant nivolumab was not administered in the comparator arm?

The NIAGARA trial evaluated the role of durvalumab as neoadjuvant/adjuvant treatment in muscle-invasive bladder cancer (MIBC). The combination chemoimmunotherapy (cisplatin, gemcitabine, and durvalumab) was given for 3 months prior to radical cystectomy, followed by adjuvant durvalumab every 4 weeks...

NIAGARA was designed and conducted prior to the approval/availability of adjuvant Nivolumab. We cannot compare the perioperative regimen of NIAGARA to adjuvant Nivolumab since the efficacy of the addition of Durvalumab to cisplatin/gemcitabine is reflected in the downstaging at the time of surgery c...

This is an important question, unfortunately, one we do not have a clear answer to. The individual contributions of the neoadjuvant and adjuvant parts of a sandwich strategy are hard to tease out, as it's not a direct comparison of similar populations. In a recent analysis of patients in NIAGARA who...