Would you consider maintenance immunotherapy after cisplatin-gemcitabine chemotherapy and chemoRT for stage 3 bladder cancer in a patient declining cystectomy or who is a poor surgical candidate?

Great question and relevant clinical scenario. We need a clinical trial in this setting, the INSPIRE (EA8185, PI: Dr. @Dr. First Last) is an ideal trial to enroll. In the meantime, would not add "consolidation/maintenance" ICI in the absence of data in this particular setting.

There are no high-level data to guide further therapy in this setting following induction cisplatin-gemcitabine chemotherapy and chemoRT for stage 3 bladder cancer in a patient declining cystectomy or who is a poor surgical candidate. Given that phase III data are unlikely to be available to guide therapy in this specific setting, principles of good clinical practice and judgment are necessary to implement. Off-trial, I would consider 'adjuvant' immunotherapy (nivolumab) if this patient has achieved clinical CR but has molecular residual disease (MRD) based on circulating tumor (ct)-DNA assessment. If the patient has responded but not achieved clinical CR, a strategy of 'maintenance' first-line avelumab for metastatic disease similar to the...