Practice Updates in Adjuvant Immune Checkpoint Inhibition for Bladder Cancer

An expert discusses how patients with muscle-invasive urothelial carcinoma (MIUC) undergoing radical cystectomy face a significant recurrence risk. High-risk factors include advanced stage, lymph node involvement, and positive surgical margins. Neoadjuvant cisplatin-based chemotherapy can improve survival but does not eliminate recurrence risk. Other predictors include lymphovascular invasion, variant histology, and systemic inflammation markers.

An expert discusses how adjuvant therapy options for high-risk muscle-invasive bladder cancer (MIBC); ypT2-ypT4a or N+) include cisplatin-based chemotherapy, which improves survival by targeting micrometastatic disease. Immune checkpoint inhibitors, such as atezolizumab and nivolumab, offer alternatives for cisplatin-ineligible patients.

An expert discusses how CheckMate 274 is a phase 3, randomized, double-blind trial evaluating adjuvant nivolumab vs placebo in patients with high-risk muscle-invasive urothelial carcinoma (MIUC) after surgery. It enrolled 709 patients, assessing disease-free survival and overall survival as primary end points.

An expert discusses how the updated results from CheckMate 274 (Galsky 2025) include updated disease-free survival (DFS) and interim overall survival (OS), along with other key end points such as nonurothelial tract recurrence-free survival (NUTRFS), distant metastasis-free survival (DMFS), and second progression-free survival (PFS2). An exploratory analysis assessed outcomes in the muscle-invasive urothelial carcinoma (MIBC) subgroup, prior neoadjuvant chemotherapy (NAC) use, and PD-L1 expression. This analysis was conducted to further evaluate efficacy across subgroups and refine the understanding of treatment impact.

An expert discusses how recent data on adjuvant anti–PD-1 trials highlight the significance of disease-free survival (DFS) and overall survival (OS), guiding clinical decisions. In muscle-invasive urothelial carcinoma (MIBC), event-free survival (EFS) and OS benefits without delaying curative cystectomy are crucial. Adjuvant nivolumab is typically initiated within 12 weeks post cystectomy, considering pathology, recovery, and performance status.