Editor's Note: Immunotherapy has rapidly developed in recent years, achieving remarkable clinical results in the treatment of advanced bladder cancer. With the continued advancement of clinical research, the application of immunotherapy has gradually expanded from advanced to locally advanced stages, including the perioperative period and even earlier stages of the disease. Immunotherapies such as durvalumab are expected to revolutionize bladder cancer treatment. At ESMO 2025, Oncology Frontier- UroStream invited Dr. Bryan Li of Queen Mary Hospital, The University of Hong Kong, to share insights.Oncology Frontier- UroStream: From ASCO to ESMO, we’ve seen a surge of exciting new data in bladder cancer. The NIAGARA regimen is drawing great attention in the MIBC field. How do you perceive the paradigm shift from conventional neoadjuvant chemotherapy to perioperative immunotherapy-based treatment?
Dr. Bryan li: I think this year is a very exciting year for treatment of muscle-invasive bladder cancer in the perioperative setting. Traditionally, our standard approach has been giving powerful cisplatin chemotherapy before removing the bladder (cystectomy). Many patients respond well initially, however, there is a significant proportion of patients that do recur after such very intensive therapy.
However, with the new incorporation of immunotherapy, for example, this time with a NIAGARA regimen, giving an anti-PD-L1 antibody, durvalumab, in the preoperative neoadjuvant as well as the adjuvant setting, together with a cisplatin-based chemotherapy.In fact, actually it helped patients to improve the progression-free survival as well as a very meaningful overall survival benefit.
I think, giving immunotherapy before operating—while the tumor is still intact—helps us ‘prime’ or educate the patient’s own immune system to recognize and attack those cancer cells proactively. Then, continuing with post-surgery doses of durvalumab reinforces and locks in that anti-cancer response. In my view, this powerful combination truly translates into excellent outcomes for our patients.
△ EFS Analysis of the NIAGARA Study
△ OS analysis of the pCR and non-pCR subgroups in the NIAGARA study
Oncology Frontier- UroStream：At this congress, health-related quality of life (HRQoL) outcomes from the NIAGARA trial evaluating perioperative durvalumab (D) plus neoadjuvant chemotherapy (NAC) in patients with muscle-invasive bladder cancer (MIBC) were presented. How do you interpret the impact of these data on current clinical practice?
Dr. Bryan li: I think, patient quality of life during treatment has always been absolutely crucial – especially in this curative setting around surgery. So whether additional of a drug would cause a detrimental, harmful effect to the quality of life is actually very important. And we are happy to see that with a combination of chemotherapy plus immunotherapy, durvalumab, we didn’t see any detrimental health-related quality of life effect, impact on the patient. So we are in a way, improving the patient’s survival, surgical outcome without causing at the without the cost of the patient’s impaired quality of life. And I think this is very reassuring for the for us in the community of oncology.
Oncology Frontier- UroStream：Because multidisciplinary coordination is so critical, could you share how muscle-invasive bladder cancer (MIBC) patients are managed in your center? What’s the referral flow between urology and medical oncology?
Dr. Bryan li: I think nowadays with the advances of the systemic therapy options in patients with muscle-invasive bladder cancer, in our center, we adopted a multi-disciplinary approach where we medical oncologists are working very closely together with surgeons, urologists, as well as radiation oncologists. So we will discuss all the patients before the operation and if the patient needs any systemic therapy, including chemotherapy or immunotherapy, we’ll be the one who’s mainly delivering it because we will be monitoring the patient’s closely and manage any potential side effects.
And in fact, when we are when we’re working as a team, we found that all of these newer systemic therapy options can be very safely delivered to patients and the surgical outcomes in indeed can improve also.
Oncology Frontier- UroStream： This year’s ESMO meeting has released a wealth of new and exciting data in the field of bladder cancer, including advances in immunotherapy, antibody–drug conjugates (ADCs), and targeted therapies. How do you see these emerging findings shaping the future treatment landscape of bladder cancer? In your opinion, what are the main directions and remaining challenges for the next stage of bladder cancer management?
Dr. Bryan li: I think this year we see a really exciting bunch of trials coming up. From my perspective, two major trends stand out.
One is that we are very reassuring that immunotherapy is going to be the game changer in management of bladder cancer patients all the way from the refractory second and third line setting to the front line setting and even in the perioperative neoadjuvant adjuvant setting. Its impact spans every stage now.
And the second one is, I think the management of bladder cancer is getting to be more and more personalized with the newer read out of trials from the antibody-drug conjugates. We see different targets and they all very showing promising results.
I think in the future, the main challenge is really how do we select patients. If patients are eligible for multiple potential regimens, how do we best select and sequence these patients? These questions remained to be answered.
Dr. LI, CHO WING Bryan
Specialist of Medical Oncology
Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
