Would you consider omitting adjuvant durvalumab in MIBC to limit overtreatment in patients who may not benefit or those who have achieved maximal benefit after neoadjuvant gem/cis/durva?

The NIAGARA protocol included neoadjuvant durvalumab in combination cisplatin/gemcitabine, followed by adjuvant durvalumab regardless of the pathologic response at the time of surgery. Therefore, even those with pCR completed the year of adjuvant therapy. What is important to point out is that we do...

The design of the NIAGARA study does not address the question regarding the relative contributions of neoadjuvant vs adjuvant components of the treatment regimen. Specifically, it is unknown whether patients who achieve complete pathologic response (pCR) at the time of radical cystectomy necessarily...

This is another unanswered question through the NIAGARA trial since all patients, including the ones who have pT0 after cystectomy, were treated with adjuvant durvalumab; hence, we do not know for sure if those patients are being overtreated. Historically speaking, patients with pT0 after neoadjuvan...

In the phase 3 NIAGARA trial, while patients with a missing assessment of pathological complete response were considered to have had no response, the number of patients with a missing pathological complete response in both groups was not provided, thus limiting the ability to evaluate potential bias...