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Cisplatin-based neoadjuvant chemotherapy can modestly improve overall survival (OS) in patients with muscle-invasive bladder cancer undergoing radical cystectomy. Recently, two adjuvant immune checkpoint studies demonstrated improvement in disease-free survival (NEJM JW Oncol Hematol Jun 2 2021 and N Engl J Med 2021 Jun 3; 384:2102; N Engl J Med 2024 Sep 14; [e-pub]).
In an industry-sponsored, international, open-label trial, 1063 patients were randomized to undergo radical cystectomy preceded by neoadjuvant gemcitabine-cisplatin (GC) for 4 cycles either with or without durvalumab (4 neoadjuvant cycles followed by 8 adjuvant cycles every 4 weeks). Of note, patients with T2N0 disease were limited to 40% of the patient population, and those wi…