Daniel P. Petrylak, MD, presented “Neoadjuvant Chemo vs. I/0 vs. ADCs” at the 7th International Bladder Cancer Update on December 6, 2024, in Dallas, Texas.
How to cite: Petrylak, Daniel P. “Neoadjuvant Chemo vs. I/0 vs. ADCs” December 2024. Accessed May 2025. https://grandroundsinurology.com/neoadjuvant-chemo-vs-i-0-vs-adcs/
Neoadjuvant Chemo vs. I/0 vs. ADCs – Summary
Daniel P. Petrylak, MD, explores the evolving role of neoadjuvant and adjuvant therapies in urothelial carcinoma, particularly in patients with muscle-invasive bladder cancer. In this 14-minute presentation, Dr. Petrylak stresses that neoadjuvant chemotherapy remains the standard of care for cisplatin-eligible patients. He references trials, such as CheckMate 274 and AMBASSADOR, highlighting adjuvant therapy’s efficacy in patients with high-risk disease post-cystectomy, showing significant disease-free survival benefits.
Dr. Petrylak introduces the NIAGARA trial, evaluating the addition of durvalumab to neoadjuvant gemcitabine-cisplatin, with findings suggesting a reduction in event-free survival risk. The EV-103 study examines enfortumab vedotin as a neoadjuvant option for cisplatin-ineligible patients, achieving a complete pathological response in 36% of cases. The role of antibody-drug conjugates continues to expand, with ongoing trials such as EV-303/KEYNOTE-095. The VGA trial assesses the impact of durvalumab and tremelimumab in patients unable to receive platinum-based chemotherapy, addressing alternative therapeutic pathways.
Dr. Petrylak shares patient reluctance toward randomized cystectomy-only arms in clinical trials underscores the challenge of accrual in bladder cancer studies. Adjuvant immune checkpoint inhibitors remain a key option for patients with residual disease following neoadjuvant chemotherapy or those with high-risk features post-surgery. The future of urothelial carcinoma management lies in refining patient selection and integrating novel therapies, ensuring optimal treatment strategies for both cisplatin-eligible and ineligible populations.
About the 7th International Bladder Cancer Update:
The International Bladder Cancer Update (IBCU) is a CME conference focused on the diagnosis and treatment of bladder cancer. The conference offers medical professionals an opportunity to listen to updates from, and interact with, expert international faculty to improve knowledge and determine best treatment practices to improve patient outcomes. IBCU encompasses expert lectures, interactive discussions, a panel roundtable, debates, and case presentations. It is physician-led, multi-supported, and designed for urologists, urologic oncologists, and other healthcare professionals involved in the treatment of bladder cancer.
For further educational activities from this conference, visit our collection page.
ABOUT THE AUTHOR
Daniel P. Petrylak, MD, leads the genitourinary cancers medical oncology team at Smilow Cancer Hospital as director of the genitourinary cancer research group, professor, and co-director of the Cancer Signaling Network program. Dr. Petrylak joined Yale from Herbert Irving Cancer Center at Columbia University Medical Center with New York-Presbyterian Hospital, where he served as Professor of Medicine (Medical Oncology) and Urology and began his appointment in September of 2012. After serving for more than 20 years as the advanced bladder chair for SWOG, Dr. Petrylak is now the Vice Chair of the Genitourinary Committee.
