VOLGA reports longer survival with a two-drug bladder-cancer treatment
Results from the phase III VOLGA trial favoured durvalumab plus enfortumab vedotin over bladder-removal surgery alone in patients unable or unwilling to receive cisplatin. Both event-free and overall survival improved. Adding tremelimumab in a separate trial arm improved event-free survival without a significant overall-survival benefit. The findings were presented at the ESMO Congress.
Science··Evening
Two medicines improved survival alongside surgery
Durvalumab with enfortumab vedotin improved survival compared with bladder-removal surgery alone in the phase III VOLGA trial. The results presented on 24 October at the European Society for Medical Oncology congress in Madrid concerned muscle-invasive bladder cancer, in which disease has reached the bladder’s muscle layer. Participants were unable or unwilling to receive cisplatin. Both event-free survival and overall survival favoured the two-drug approach. Urology Times reported the same trial development alongside the congress coverage. The comparison addresses a defined patient group for whom a commonly used chemotherapy option was unsuitable or declined, with treatment arranged around radical cystectomy, the operation that removes the bladder.[1], [2]
A third agent showed a different survival result
A separate treatment arm also included tremelimumab. That three-drug approach prolonged event-free survival without demonstrating a statistically significant overall-survival improvement. The two-drug and three-drug findings consequently describe different results. Durvalumab acts on an immune checkpoint, helping release a brake on immune activity. Enfortumab vedotin is an antibody–drug conjugate, carrying a drug payload through an antibody directed at nectin-4. In VOLGA it was administered before surgery. The congress discussion raised its possible postoperative contribution as a question for further research. Treatment timing matters within this trial’s interpretation: a result for the tested sequence does not determine the value of every alternative sequence.[1]
Nerve, skin and blood-sugar effects accompanied treatment
Reported adverse effects included skin reactions, peripheral neuropathy and hyperglycaemia. These refer to problems affecting skin, nerves outside the brain and spinal cord, and elevated blood sugar. The efficacy findings therefore accompany a safety profile requiring clinical assessment. Earlier bladder-cancer trials tested enfortumab vedotin with pembrolizumab, a different immune-treatment partner. Those regimens should be distinguished from the durvalumab combination examined in VOLGA. The congress account also placed the findings in the wider investigation of antibody-delivered drugs in urothelial cancer. Products in that class have different targets and payloads, and have not all yielded similar survival results. VOLGA’s reported benefit belongs to the medicines and defined clinical population. In the earlier TROPiCS-04 investigation, sacituzumab govitecan showed no significant survival improvement.[1]
