Germ Cell / Other GU

2026-05-30 ASCO Annual Meeting 2026

Living Longer, Living Better: GU Oncology Review (Rini)

TL;DRDiscussant round-up on curing GU cancers without sacrificing QoL: bladder-preservation chemoRT ± durvalumab, EV-based sparing, ctDNA-guided adjuvant RCC selection.

Trials discussed

EV209EV309RAMPART

vs leading data

EV309 is the RT-relevant readout: EV+pembro randomized directly against chemoradiotherapy for bladder preservation, with an OS endpoint

Curative ASCO Annual Meeting 2026

RT: full 55 Gy/20 fx 54/54 (100%), no extension/delay 47/54 (87%). Durvalumab completed 33/54 (61%).

+1 more figure

Living Longer, Living Better: GU Oncology Review (Rini)

10 details 4 trials watching

Methods

💊 Adding durvalumab to mitomycin/5-FU chemoRT didn't compromise RT or chemo delivery (discussant read)
🔍 EV + pembrolizumab bladder-sparing trials in MIBC

EV209 EV309

Population cystectomy-eligible cT2-4a N0 ineligible/refusing cT2-4a N0
N 240 390
Design 9 cycles EV + 1yr pembro randomized vs chemoradiotherapy
Endpoints cCR rate, 2yr BIEFS BIEFS, OS
🔍 RAMPART (adjuvant IO, RCC): non-clear cell subgroups underpowered, few pts/events, wide CIs, central path review ongoing
🔍 ctDNA vs pathology for adjuvant RCC selection (Choueiri): pathologic features called a crude selection tool

	EV209	EV309
Population	cystectomy-eligible cT2-4a N0	ineligible/refusing cT2-4a N0
N	240	390
Design	9 cycles EV + 1yr pembro	randomized vs chemoradiotherapy
Endpoints	cCR rate, 2yr BIEFS	BIEFS, OS

Results

📊 ctDNA-negative 24-mo DFS 79.9% (pembro, n=344) vs 72.9% (placebo, n=332)
📊 ctDNA-positive (n=30/arm) markedly worse: median DFS 10.1 and 6.4 mo, both arms poor

Critique

⚠️ Long-term bladder preservation, function, symptom burden, QoL + safety still need longer f/u (discussant)
⚠️ Adjuvant IO has no proven benefit in non-clear cell RCC (discussant)
⚠️ Only 30 ctDNA-positive pts/arm; hypothesis-generating, assay not yet a standard selection tool

Notes

🔬 Discussant session (Rini, ASCO 2026) framing the curative-intent vs QoL tension across GU; multiple trials, not one new result

Open questions

Long-term QoL and safety of durvalumab added to bladder-preservation chemoRT

active A Study of Chemotherapy and Radiation Therapy Compared to Chemotherapy and Radiation Therapy Plus MEDI4736 (Durvalumab) Immunotherapy for Bladder Cancer Which Has Spread to the Lymph Nodes, INSPIRE Trial Phase 2

n=11 · primary completion 2026-02 · durvalumab added to chemoRT, node+ bladder
Whether EV-based bladder sparing matches chemoradiotherapy

recruiting Enfortumab Vedotin Plus Pembrolizumab With Selective Bladder Sparing for Treatment of Muscle-invasive Bladder Cancer Phase 2

n=47 · primary completion 2027-11 · EV+pembro selective bladder sparing in MIBC

recruiting A Study to Find Out if Enfortumab Vedotin Given With Pembrolizumab Helps People With Muscle-invasive Bladder Cancer Keep Their Bladder Phase 2

n=240 · primary completion 2027-11 · EV+pembro bladder preservation in MIBC
ctDNA-guided patient selection for adjuvant therapy in RCC

recruiting Renal Cancer Monitoring Based on ctDNA Methylomics: A Prospective Cohort Study (MEMORY Study)

n=450 · primary completion 2028-06 · ctDNA methylation monitoring post-RCC surgery

📚 Sources · 🐦 1 tweet

#ASCO26 GU Oncology Spotlight 🚨

🔬 Living Longer, Living Better: Can We Have It All?
Discussant: Brian I. Rini, MD, FASCO@OncoAlert @ASCO

This GU session captured one of the central tensions in curative-intent oncology:
Can we improve cure rates while preserving quality of… pic.twitter.com/AMwrRZZM2Q
— Dra. María Natalia Gandur Quiroga (@nataliagandur) May 30, 2026