Dra. María Natalia Gandur Quiroga

@nataliagandur

Oct 24

International Urology Cancer Summit

@urologysummit

Oct 24

🚨⭐ #ESMO26 | GU ONCOLOGY — DAY 2 HIGHLIGHTS

A major day for bladder and prostate cancer: practice-relevant phase III data, longer survival follow-up and new molecular clues.

🟠 VOLGA | LBA2 — A pivotal MIBC result

In cisplatin-ineligible/refusing MIBC, perioperative t enfortumab vedotin vs radical cystectomy ± approved adjuvant therapy:

✅ 2-year EFS: 64% vs 45% | HR 0.51
✅ 2-year OS: 78% vs 69% | HR 0.58

A meaningful survival signal, but not a head-to-head comparison with EV + pembrolizumab.

🔵 DASL-HiCaP | LBA4 — Intensification with radiotherapy

Darolutamide + ADT + RT improved 4-year metastasis-free survival to 95% vs 88% (HR 0.42) in very-high-risk prostate cancer.

OS remains immature; this use is investigational.

🔵 PEACE-1 | 2215O — Durability matters

After 7.7 years' follow-up in de novo mCSPC, ADT + docetaxel + abiraterone delivered median OS of 6.2 vs 4.4 years (HR 0.68).

Eight-year OS: 40.3% vs 27.1%.

🔵 PROTEUS substudy | LBA53

Perioperative apalutamide + ADT around prostatectomy vs surgery alone in high-risk localised disease:

✅ EFS HR 0.38 (n=408).

Promising but setting-specific evidence; longer follow-up matters.

🧬 STAMPEDE / Decipher | 2045O

Genomic risk may help identify patients deriving greater benefit from abiraterone for distant-metastasis prevention.

Retrospective biomarker evidence—not yet a mandate to de-escalate.

🟠 NIAGARA molecular analysis | 4741RO

Exploratory EFS signals across several molecular subtypes, including basal-squamous disease.

No validated biomarker yet to withhold perioperative durvalumab.

🟠 EV-103 | 4740RO

Long-term EV + pembrolizumab follow-up in advanced urothelial cancer:

✅ Estimated 5-year OS: 33% in pooled cohorts.

Durability and late toxicity both matter.

🟠 GDFATHER-NEO | 4757RO

Visugromab + nivolumab:
✅ pCR 33.3% vs 7.7% with nivolumab + placebo.

Exciting but exploratory (n=28 evaluable).

⭐ MY CLINICAL PEARL

Not every form of intensification is equal.

What matters is proven survival or metastasis prevention, alongside toxicity, patient selection and quality of life.

Precision AND durable benefit—not just higher response rates.

@gbanna74 @ravikanesvaran @nataliagandur @neerajaiims @Sebastiano_Buti @CinziaConted @dralishadamani @amg120395 @PGrivasMDPhD @koshkin85 @MicheleMaffezz @ParamMariappan @dmukherji @VanitaNoronha @montypa @DanieleRaggi83 @PasRescigno @jteoh_hk @alison_tree @DrYukselUrun @yekeduz_emre @AgrawalTrush @AndrewKevinAlo1

#ESMO26 #GUOncology #BladderCancer #ProstateCancer #MIBC #mCSPC #PrecisionOncology

Dra. María Natalia Gandur Quiroga

@nataliagandur

Oct 24

International Urology Cancer Summit

@urologysummit

Oct 23

🚨⭐ #ESMO26 | GU ONCOLOGY — DAY 1 HIGHLIGHTS
@OncoAlert

🟠🔵 From perioperative immunotherapy to molecular precision and next-generation treatments.

A remarkable opening day in GU oncology, with important lessons for both #BladderCancer and #ProstateCancer.

Here are our key 🟠 1️⃣ KEYNOTE-866 Abstract 4735O

❌ Perioperative pembrolizumab + gemcitabine/cisplatin failed to significantly improve EFS in cisplatin-eligible MIBC.

📊 EFS HR 0.88 (95% CI 0.71–1.10)
p=0.1366

pCR: 44.4% vs 35.8%

💡 Higher pathological response did not translate into a statistically significant EFS benefit.

🟠 2️⃣ ENERGIZE Abstract 4736O

❌ Perioperative nivolumab + chemotherapy also failed to meet its co-primary endpoints.

📊 EFS HR 0.94; p=0.6697
pCR: 39.1% vs 29.6%

🔬 These findings reinforce the need to interpret response endpoints alongside durable clinical outcomes.

🟠 3️⃣ KEYNOTE-905 & KEYNOTE-B15 | 4733O / 4734O

✅ The exploratory three-arm KEYNOTE-905 analysis favored EV + pembrolizumab over surgery alone.

📊 OS HR 0.48
pCR: 58.8% vs 25.3% with pembrolizumab alone and 10.3% with surgery alone.

🧬 KEYNOTE-B15:
ctDNA clearance with EV + pembrolizumab vs gemcitabine/cisplatin:

✅ 82.1% vs 66.7%

ctDNA positivity was associated with poorer EFS.

📌 Molecular monitoring offers exciting opportunities for risk stratification, but ctDNA-guided treatment decisions still require prospective validation.

🟠 4️⃣ TROPHY-U-01 COHORT 7 4742O

💊 SG + EV + zimberelimab in untreated metastatic urothelial cancer.

✅ ORR: 81%
✅ Median PFS: 19.3 months
✅ Median DoR: 16.7 months

⚠️ Phase Ib, only 21 patients, with substantial toxicity.

Promising—but not yet practice-changing.

🔵 5️⃣ CAPItello-281 LBA56

Updated overall survival in PTEN-deficient de novo mHSPC.

📊 Capivasertib + abiraterone vs placebo + abiraterone:

✅ Median OS: 57.4 vs 46.5 months
HR 0.82 (95% CI 0.68–0.99)

⚠️ The prespecified statistical significance threshold was not met.

An encouraging survival signal, but not a formally established OS benefit.

🔵 6️⃣ THE NEXT FRONTIER IN PROSTATE CANCER

Today's educational sessions highlighted major advances in:

☢️ PSMA-targeted radioligand therapy
🧬 AR degraders and RIPTACs
💊 Next-generation ADCs
🔬 T-cell engagers and precision immunotherapy

The key challenge is moving from promising biological activity toward durable clinical benefit, acceptable toxicity and better patient selection.

⭐ POINT OF VIEW

More treatment does not always mean better outcomes. And an impressive response rate does not automatically establish a new standard of care.

Today's data reinforce three essential principles:

✅ Robust survival endpoints matter.

✅ Biomarkers must move from prognostic value to validated therapeutic guidance.

✅ Novel combinations require careful assessment of efficacy, toxicity and clinical applicability.

💡 The future of GU oncology is not simply treatment intensification—it is smarter, biologically informed treatment selection.

🎯 The right strategy. The right patient. The right time.

Outstanding scientific discussions throughout Day 1!

@gbanna74 @ravikanesvaran @nataliagandur @neerajaiims @Sebastiano_Buti @CinziaConted @dralishadamani @amg120395 @PGrivasMDPhD @koshkin85 @MicheleMaffezz @ParamMariappan @dmukherji @VanitaNoronha @montypa @DanieleRaggi83 @PasRescigno @jteoh_hk @alison_tree @DrYukselUrun @yekeduz_emre @AgrawalTrush

@ONCOassist @VuMedi @ProstateUK @OncologyNT @OncJournal

#GUOncology #BladderCancer #ProstateCancer #mCRPC #MIBC #PrecisionOncology