Andrea Necchi, MD, on evolving perioperative treatment approaches for MIBC

In this video, Andrea Necchi, MD, FASCO, of Vita-Salute San Raffaele University in Milan, Italy, discusses findings from the phase 3 CA017-078/ENERGIZE trial of perioperative nivolumab (Opdivo) plus gemcitabine and cisplatin in patients with muscle-invasive bladder cancer (MIBC), comparing the results with other perioperative immunotherapy trials and examining how antibody-drug conjugate (ADC) combinations are reshaping multidisciplinary treatment approaches.

The final analysis of CA017-078 found no statistically significant improvement in event-free survival (EFS) or pathologic complete response (pCR) with neoadjuvant nivolumab plus gemcitabine and cisplatin followed by adjuvant nivolumab compared with neoadjuvant chemotherapy alone.¹ Among 653 patients, the 2 treatment groups had an EFS hazard ratio of 0.94 (95.74% CI, 0.71 to 1.25; P = .6697). The pCR rates were 39.1% and 29.6%, respectively. Necchi contextualizes these findings alongside other perioperative studies, including NIAGARA, noting the challenges of achieving response rates with chemotherapy-based regimens that could justify substantially changing the role of radical cystectomy.

Necchi explains that emerging ADC-based combinations are prompting clinicians to reconsider established treatment pathways for MIBC, particularly the relationship between systemic therapy and local treatment. He describes growing interest among urologists and oncologists in approaches that could spare selected patients from radical cystectomy while maintaining effective disease control. This shift underscores the importance of multidisciplinary collaboration and careful patient selection when evaluating bladder-preserving strategies.

“Urologists are very much motivated to reshape the way they conceive cystectomy in these patients,” Necchi says. He also highlights the importance of training urologists to perform high-quality trimodality therapy, including chemoradiation and transurethral resection of bladder tumor (TURBT), to help optimize outcomes as new treatment options emerge.

REFERENCE
1. Necchi A, Gupta S, van der Heijden MS, et al. Results from a phase 3 trial of neoadjuvant (neoadj) chemotherapy alone vs in combination with nivolumab followed by postsurgical adjuvant nivolumab in patients (pts) with muscle-invasive bladder cancer (MIBC). Presented at: 2026 European Society for Medical Oncology Congress. October 23-27, 2026. Madrid, Spain. Abstract 4736O