Bladder cancer drug combination cuts risk of serious disease events by 49% in major trial

A treatment combination tested through an international trial coordinated by a London NHS cancer specialist has significantly improved outcomes for people with muscle-invasive bladder cancer who could not receive, or chose not to receive, standard cisplatin chemotherapy.

Patients received durvalumab and enfortumab vedotin before surgery to remove the bladder, followed by durvalumab afterwards. Compared with surgery alone, the approach reduced the combined risk of the cancer progressing or returning, surgery not taking place, or death by 49%. After two years, 64% of patients receiving the combination remained alive without one of these events, compared with 45% in the standard-care group.

The treatment also reduced the risk of death by 42%. An estimated 78% of patients given the drug combination were alive after two years, compared with 69% of those receiving standard care.

The Phase III VOLGA trial was conducted at 182 hospitals in 25 countries, with eight participants treated through Barts Health NHS Trust. Professor Thomas Powles, chair of Barts Cancer Centre, served as its international coordinating investigator. The study focused on patients with cancer that had grown into the bladder wall and who faced limited treatment options because cisplatin chemotherapy was unsuitable or had been declined.

Serious grade 3 or 4 adverse events were reported in 64% of patients receiving the new combination, compared with 44% in the comparator group. Researchers reported no new safety signals, but further assessment and regulatory scrutiny will be required.

The combination is not currently licensed in the UK for this use and has not been approved for routine NHS treatment. The findings are therefore potentially practice-changing, but patients should not expect the treatment to become immediately available outside clinical trials or future approved pathways.

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