A New Hope For Bladder Cancer Patients Who Can't Tolerate Chemo
- Nearly half of muscle-invasive bladder cancer patients can’t tolerate chemotherapy drug, cisplatin. VOLGA is the first major trial to give them an effective alternative, combining two immunotherapies (durvalumab + tremelimumab) with a targeted therapy (enfortumab vedotin) given around the time of surgery.
- The trial shows that the durvalumab + EV combination improved both event-free survival and overall survival in this previously underserved population.
- The regimen is well-tolerated even in older patients — and early side effect reporting is key to staying on treatment as long as possible.
- For the first time, there is a real path to cure for cisplatin-ineligible patients.
As Dr. Alexandria Drakaki, a medical oncologist at UCLA, explains, “There is hope to cure this disease and make it a chronic disease — make patients be survivors and not needing direct cancer therapy.”
Positive Data For Patients
Read MoreThe trial tested combinations of three drugs:
- Durvalumab (Imfinzi): An immunotherapy drug that helps the immune system recognize and attack cancer cells (a PD-L1 inhibitor)
- Tremelimumab (Imjudo): A second immunotherapy that works alongside durvalumab to further activate the immune response (a CTLA-4 inhibitor)
- Enfortumab vedotin (EV): A targeted therapy that delivers chemotherapy directly to cancer cells, minimizing damage to healthy tissue
This is the first trial to combine two immune checkpoint inhibitors with a targeted therapy in this setting, a genuinely novel approach.
Dr. David Aggen, a medical oncologist at Memorial Sloan Kettering, says the VOLGA data reinforce how active EV is when paired with a checkpoint inhibitor like durvalumab.
“We’re entering a new era,” Dr. Aggen tells SurvivorNet.
He adds that “where more active regimens may allow us to test bladder‑sparing approaches while still maintaining cure rates.”
A Much-Needed Alternative To Chemotherapy
This trial addressed a real unmet need. Cisplatin can cause serious kidney damage and hearing loss, side effects that mean it is not an option for many patients. Now, for the first time, those patients have an effective, well-tolerated alternative. Even in older patients, this regimen has shown a manageable safety profile.
“For decades, patients that were cisplatin ineligible were sort of neglected — they were just going for surgery. They wouldn’t have good treatments that were safe and effective. And so now we have a novel combination of drugs,” Dr. Drakaki says.
She stresses that the timing will be key going forward.
“I feel there is one chance of cure and this is when they’re still in this muscle invasive state. It’s very important to use the best available treatment,” she says.
The key takeaway here is that results from the VOLGA trial indicate that there are more options for people facing difficult bladder cancer diagnoses.
The trial also indicated that the safety profile of Imfinzi and EV, with or without Imjudo, was consistent with known safety profiles for the individual medications. No new safety concerns were identified.
Still, it is important for patients to report any new or developing side effects to their medical teams.
Questions To Ask Your Doctor
- Am I a candidate for the VOLGA regimen, Imfinzi plus Imjudo and EV?
- What side effects should I be aware of?
- What are my options if side effects become unmanageable?
- What are the risks/benefits of receiving additional treatment before and after surgery?
Learn more about SurvivorNet's rigorous medical review process.
