Oncology Today with Dr Neil Love Urothelial Bladder Cancer — Microlearning Activity 2 with Dr Terence Friedlander: ESMO Congress 2025 Review
Feb 23, 2026
Dr Terence Friedlander, UCSF medical oncologist and bladder cancer investigator, discusses selection and sequencing of therapies and highlights key ESMO 2025 findings. He covers NIAGARA perioperative results, ADCs targeting HER2 and Trop-2, cross-resistance and payload concerns, T-DXd activity and ILD risk, and practical sequencing for frail or chemo-ineligible patients.
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Niagara Shows Efficacy Without QoL Tradeoff
- Perioperative dervalumab added to cisplatin/gemcitabine (Niagara) improved outcomes without meaningful QoL detriment.
- Quality of life curves for pain and urologic symptoms nearly overlapped, supporting tolerability of the GEMSYS‑DERVA regimen.
Niagara Marked A Rare Neoadjuvant Win
- Niagara was first positive phase III neoadjuvant bladder cancer trial in ~15–20 years, establishing benefit of adding a checkpoint to cis‑gem.
- Its role may shift if EVP shows similar benefit in cisplatin‑eligible patients, complicating regimen choice.
Avoid Enfortumab With Poorly Controlled Diabetes Or Severe Neuropathy
- Avoid enfortumab vedotin (EV) in patients with poorly controlled diabetes or blood glucose above 250 and consider neuropathy risk before choosing EV versus cisplatin.
- Cisplatin also complicates diabetes care due to steroid antiemetic needs, limiting clean alternatives.