Would you recommend adjuvant cisplatin/gemcitabine or nivolumab in a patient with muscle invasive bladder CA who proceeded to radical cystectomy first?

This is an excellent question and one we are seeing more and more in clinics these days now that the FDA has approved nivolumab for adjuvant therapy for patients with locally advanced urothelial carcinoma at high risk of recurrence after radical resection. This is based on data from CheckMate 274 wh...

CheckMate 274 reported that in patients with high-risk muscle-invasive urothelial carcinoma who had undergone radical surgery, disease-free survival was longer with adjuvant nivolumab (vs placebo) in the intention-to-treat population (median 20.8 vs. 10.8 months, HR 0.70, P<0.001) and among patients...

At the present moment, overall survival data is not yet available regarding adjuvant Nivolumab post-cystectomy. Therefore, at present, if patients meet the criteria to safely receive Cisplatin, I prioritize adjuvant Cisplatin-based chemotherapy in my treatment discussions with patients. I do, howeve...

For a patient who proceeds to radical cystectomy first with high-risk MIBC (pT3, pT4a, or pN+), based on the limitations of the CM274 data and the specific eligibility criteria that were used in the study (i.e., not eligible for or declined adjuvant cisplatin-based combination chemotherapy), I would...

My recommendation for therapy would be dependent on the individual patient. In the CheckMate 274 trial, patients with ypT2-ypT4a disease or ypN+ muscle invasive urothelial carcinoma (MIUC) after receiving neoadjuvant chemotherapy (NAC) or those with pT3-pT4a or pN+ MIUC who did not receive cisplatin...

In patients who were not given neoadjuvant cisplatin-based chemotherapy and pathologic T3, T4, or N+ disease after cystectomy, data suggests overall survival benefit with adjuvant cisplatin-based chemotherapy. (Advanced Bladder Cancer (ABC) Meta-analysis Collaboration, PMID 15939530). Thus, adjuvant...