Germ Cell / Other GU
2026-05-30 ASCO Annual Meeting 2026
Living Longer, Living Better: Can We Have It All?
TL;DRASCO26 GU discussant on curative-intent trade-offs: bladder-sparing chemoRT + IO feasibility, and ctDNA over pathology for adjuvant RCC selection.
EV209EV309RAMPART
The RT read is delivery feasibility: layering durvalumab onto 55 Gy/20 fx chemoRT left radiotherapy fully intact (100% completed full dose), so the 39% early durvalumab stops reflect IO tolerability, not RT. Supports adding IO to bladder-preservation chemoRT, but bladder-intact and QoL endpoints remain immature.
- RAMPART (adjuvant RCC): non-clear-cell subgroups have few pts/events and wide CIs; no proven adjuvant IO benefit in non-clear-cell RCC
- Session throughline: organ sparing (bladder) and biomarker-refined de-escalation (ctDNA over pathology) without sacrificing cure
| Component | n (%) |
|---|---|
| Full 55 Gy/20 fx RT delivered | 54 (100%) |
| RT with no extension/delay | 47 (87%) |
| Chemo discontinued early | 12 (22%) |
| Durvalumab completed | 33 (61%) |
| Durvalumab discontinued early | 21 (39%) |
+1 more figure
6 details 3 trials watching
- 🔍 Bladder preservation thread: durvalumab added to mitomycin C / 5-FU chemoRT (55 Gy/20 fx) in MIBC
- 💊 Durvalumab drove the early discontinuations (toxicity / PD); chemoRT delivery itself was not compromised
- 🔍 EVP (enfortumab vedotin + pembrolizumab) bladder-sparing trials in MIBC
Feature EV209 EV309 Population Cystectomy-eligible Ineligible / refusing Stage cT2-4a N0 MIBC cT2-4a N0 MIBC N 240 390 Regimen 9 cycles EV + 1 yr pembro 9 cycles EV + 1 yr pembro Endpoints cCR, 2 yr BIEFS BIEFS, OS
- 📊 Adjuvant pembro (Choueiri, ASCO26): ctDNA stratifies DFS better than pathologic features; ctDNA-positive pts fare far worse in both arms
- ⚠️ Feasibility signal only; bladder preservation, function, symptom burden, safety and QoL all await longer f/u
- 🗞️ Rini ASCO26 GU discussant: can curative-intent GU therapy raise cure rates while preserving organ function and QoL?
- Long-term bladder preservation, function, and QoL after durvalumab chemoRT active Carboplatin, Nab-Paclitaxel, Durvalumab Before Surgery and Adjuvant Therapy in Head and Neck Squamous Cell Carcinoma Phase 2n=39 · primary completion 2022-02 · candidate match
- ctDNA vs pathology for selecting adjuvant IO in RCC n=30 · primary completion 2027-06 · candidate match
- Enfortumab vedotin bladder-sparing efficacy (BIEFS, OS) in MIBC n=30 · primary completion 2025-09 · candidate match
📚 Sources · 🐦 1 tweet
#ASCO26 GU Oncology Spotlight 🚨
— Dra. María Natalia Gandur Quiroga (@nataliagandur) May 30, 2026
🔬 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