Nick James retweeted
Yet another positive diet, exercise, lifestyle trial....for men on ADT at high-risk of toxicity.
The STAMINA RCT - thelancet.com/journals/lanon…
The STAMINA RCT - thelancet.com/journals/lanon…
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Nick James retweeted
Back in 🇬🇧 but still able to listen to @nickva1 presenting @ASTRO_org #ASTRO26 @royalmarsdenNHS @EmmaHall71 No surprises here, patients have better sexual outcomes after SBRT compared to prostatectomy
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I never viewed it as in any way clinically relevant. It’s just a way of counting relapses consistently for trials. Threshold for imaging should be driven by the imaging you have available. Plus the relevant pathology etc.
Great article below 👇 - it’s time to rethink biochemical relapse thresholds. Many oncologists are no longer waiting for nadir+2 to image, so I support the need for a new framework for practice.
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Nick James retweeted
Doctors hail drug that spares bladder cancer patients ‘life-changing’ surgery | Cancer research | The Guardian. Great to see our RADio trial highlighted by guardian. Study investigated addition of Durvalumab to concurrent chemo RT. @Prof_Nick_James theguardian.com/science/2026/j…
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We have a number of professors of statistics on the author list and the paper has passed through peer statistical review at a high impact journal. I cannot comment on the specifics of the stats comments in this post but am confident in my co-authors’ knowledge in this area.
My brain doesn’t do stats. What do STAMPEDE team think of this critique, @Prof_Nick_James ?
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Great to meet you all!
Delighted to have an Inspiring and insightful discussion with @Prof_Nick_James @ProfSyedHussain @saadnasir01 at the ASCO2026.
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Nick James retweeted
New data in @Annals_Oncology: A target trial emulation of >229K obese, nondiabetic adults shows GLP-1RA use is associated with a 41% reduction in obesity-associated cancers compared to lifestyle modifications alone (HR 0.59). - Congratulations to Aparna Kamat, Arthur Hsu, @p@MethodistHosp team
annalsofoncology.org/article/S0923-…
@SGO_org
annalsofoncology.org/article/S0923-…
@SGO_org
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Delighted that our STAMPEDE paper on abiraterone therapy selection with MMAI in high risk M0 HSPC now out. kwnsfk27.r.eu-west-1.awstrack.me/L0/https:%2F%2…
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Nick James retweeted
80% disease free survival at 1 year in bladder preserving Rx for MIBC using durvalumab and chemoradiotherapy. A significant step up from historical controls @Prof_Nick_James
#ASCO26 🔬 Abstract 4504 | RAD-IO
Durvalumab + chemoradiotherapy in muscle-invasive bladder cancer
Presented by Nicholas D. James, PhD, MBBS, FRCP
@OncoAlert
@ASCO
Bladder preservation in MIBC remains one of the most important curative-intent questions in GU oncology.
The key mmune checkpoint inhibition be safely integrated with standard chemoradiotherapy?
RAD-IO evaluated durvalumab with bladder-directed chemoradiotherapy using 5-FU + mitomycin C in patients with muscle-invasive bladder cancer.
🧪 Study design
Stage 2 efficacy cohort:
• T2 N0–2 M0 MIBC
• CRT + durvalumab
• Single-arm phase II design
• Primary endpoint: 12-month disease-free survival
• 12-month DFS used as a surrogate for longer-term outcome
The trial used a clear GO / NO-GO framework:
🟢 GO: DFS ≥75%
🟡 Contextual: 60–75%
🔴 NO-GO: <60%
📌 Feasibility
Among 54 participants who started treatment:
• 100% received full radiotherapy: 55 Gy in 20 fractions
• 0 stopped radiotherapy early
• 87% had no RT extension or delay
• 100% received mitomycin C
• 100% received week 1 5-FU
• 78% received week 4 5-FU
• 61% completed planned durvalumab
• 39% discontinued durvalumab early
So, delivery of CRT was highly feasible, while immunotherapy completion was more challenging.
📊 Primary outcome
At 12 months post-CRT:
• DFS rate: 80%
• 40/50 disease-free
• 95% CI: 0.67–0.89
This crossed the prespecified GO threshold.
Secondary outcome PFS was consistent:
• No event: 83.6%
• Distant metastasis: 9.1%
• Local disease: 7.3%
💬 My take
RAD-IO provides an encouraging signal that durvalumab can be integrated with bladder-preserving chemoradiotherapy in MIBC.
But this is not yet practice-changing.
Important caveats:
🔹 single-arm phase II design
🔹 12-month endpoint
🔹 no randomized comparator
🔹 durability and late toxicity remain critical
🔹 completion of durvalumab was imperfect
Still, this is a very relevant direction.
In an era where systemic therapy is becoming increasingly active in urothelial cancer, bladder preservation strategies need to evolve too.
The next question is not simply whether CRT works.
It is:
➡️ Which patients are best suited for bladder preservation?
➡️ Can immunotherapy improve cure without compromising safety?
➡️ How should we integrate systemic therapy, radiation, surgery, and patient preference?
For MIBC, the future may be a more personalized curative-intent pathway — not one-size-fits-all cystectomy versus CRT.
#ASCO26 #GUOnc #BladderCancer #UrothelialCancer #MIBC #Immunotherapy #RadiationOncology #BladderPreservation
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Exactly, only around half, yet still looks v similar to other groups’ TMT data. A subgroup had biopsy only and still did fine. We presented this at ESMO a while ago (but not published sorry)
@Prof_Nick_James I cite your data often! But in this trial 56% received a complete resection so hard to argue against it.
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Nick James retweeted
@CedricPetersRT @Prof_Nick_James The data showing ⬇️outcomes when complete TURBT not done is almost certainly a surrogate marker of more advanced disease, which not surprisingly does worse. Appreciate @Prof_Nick_James sharing their experience. An extra procedure + creation of more hypoxia does seem low value.
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Nick James retweeted
Today’s decision from the Health Secretary on prostate cancer screening is a missed opportunity - too timid, too slow, and lacking the bold ambition that we so desperately wanted to see.
As I set out last week, I fundamentally disagree with the National Screening Committee’s advice on a future screening programme for prostate cancer, which is far too narrow. I strongly believe that if we are really to get on top of prostate cancer - the most common cancer in British men - then a proper, targeted screening programme for all those at higher risk is needed… and needed now.
I welcome expanded provision of focal therapy, which I benefited from last year with my own cancer; this must be an urgent priority to make available across the NHS. And the recognition that more work is needed to screen at risk groups, such as black men, is important.
But this was an opportunity for bold, decisive, life-saving action - action that would help save the heartache of too many families losing a loved-one to this disease. That, sadly, has been missed. We will continue the campaign to urge the Government to go further, faster and put in place a progressive policy that includes a proper screening programme for the most at-risk men.
As I set out last week, I fundamentally disagree with the National Screening Committee’s advice on a future screening programme for prostate cancer, which is far too narrow. I strongly believe that if we are really to get on top of prostate cancer - the most common cancer in British men - then a proper, targeted screening programme for all those at higher risk is needed… and needed now.
I welcome expanded provision of focal therapy, which I benefited from last year with my own cancer; this must be an urgent priority to make available across the NHS. And the recognition that more work is needed to screen at risk groups, such as black men, is important.
But this was an opportunity for bold, decisive, life-saving action - action that would help save the heartache of too many families losing a loved-one to this disease. That, sadly, has been missed. We will continue the campaign to urge the Government to go further, faster and put in place a progressive policy that includes a proper screening programme for the most at-risk men.
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Agree but would go even further and roll out to all men over 45
Today’s decision from the Health Secretary on prostate cancer screening is a missed opportunity - too timid, too slow, and lacking the bold ambition that we so desperately wanted to see.
As I set out last week, I fundamentally disagree with the National Screening Committee’s advice on a future screening programme for prostate cancer, which is far too narrow. I strongly believe that if we are really to get on top of prostate cancer - the most common cancer in British men - then a proper, targeted screening programme for all those at higher risk is needed… and needed now.
I welcome expanded provision of focal therapy, which I benefited from last year with my own cancer; this must be an urgent priority to make available across the NHS. And the recognition that more work is needed to screen at risk groups, such as black men, is important.
But this was an opportunity for bold, decisive, life-saving action - action that would help save the heartache of too many families losing a loved-one to this disease. That, sadly, has been missed. We will continue the campaign to urge the Government to go further, faster and put in place a progressive policy that includes a proper screening programme for the most at-risk men.
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Nice piece of coverage for our RADIO data presented at #asco26 theguardian.com/science/2026/j…
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Not sure how failure to make things worse is a good outcome for an expensive treatment!
The #OncoAlertTopTweet 🚨Day FOUR #ASCO26
Post by @OncoAlert Faculty @DrChoueiri 🇺🇸
POTOMAC
5-year OS update presented by Dr Maria De Santis: Durvalumab + BCG (I+M) continues to show no detriment to OS vs BCG alone in BCG-naive high-risk NMIBC (5-yr OS 87.6% vs 86.3%), with no major impact on quality of life
@DrChoueiri 🇺🇸 @hoperugo 🇺🇸 @matteolambe 🇮🇹 @TiansterZhang 🇺🇸 @CathyEngMD 🇺🇸 @stolaney1 🇺🇸 @montypal 🇺🇸 @tompowles1 🇬🇧 @brian_rini 🇺🇸 @cdanicas 🇪🇸 @NiuSanford 🇺🇸 @amerseburger 🇩🇪 @GlopesMd 🇺🇸 @Icro_Meattini 🇮🇹 @PGrivasMDPhD 🇺🇸 @DrYukselUrun 🇹🇷 @nataliagandur 🇦🇷 @ElisaAgostinett 🇧🇪 @HHorinouchi 🇯🇵 @realbowtiedoc 🇺🇸 @to_be_elizabeth 🇮🇹 @UOzkerim 🇹🇷 @Erman_Akkus 🇹🇷 @yekeduz_emre 🇹🇷 @p_ciracimd 🇮🇹 @DrVilmaPBarcia 🇪🇸 @DraMartinezLago 🇪🇸 @DrMirallas 🇺🇸 @GaiaGriguolo 🇮🇹 @MarioBalsaMD 🇪🇸 @scocmem 🇬🇧 @AmandaNizamMD 🇺🇸 & @weoncologists 🇺🇸
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Spot on
There’s no getting away from the fact that this is a missed opportunity for men’s health.
The chance to stop more fathers, brothers and sons dying before their time has not been seized.
I will continue to campaign with @PCR_News for a targeted screening programme for prostate cancer because the evidence shows that will save lives.
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