New Questions in Muscle-Invasive Bladder Cancer After the NIAGARA Trial

Albert Jang, MD University Hospitals of Cleveland | Michael Serzan, MD Dana-Farber Cancer Institute

Key Points

• Perioperative durvalumab with neoadjuvant chemotherapy prior to surgery is the new standard of care in muscle-invasive bladder cancer (MIBC).

• Experts discuss the necessity of adjuvant durvalumab in treating patients with MIBC.

• One question involves understanding the potential role of circulating tumor DNA (ctDNA) in guiding treatment intensity.

The results of the NIAGARA trial have yielded a new standard of care for patients with MIBC, according to Michael Serzan, MD, of Dana-Farber Cancer Institute.  

While speaking with Albert Jang, MD, of University Hospitals of Cleveland, at the 2025 American Society of Clinical Oncology (ASCO) Annual Meeting, Dr. Serzan highlighted some new questions regarding perioperative durvalumab that emerged after the trial.   

For example, regarding ctDNA’s potential role in guiding treatment intensity, Dr. Serzan raised the question of whether all patients require continued adjuvant durvalumab or if treatment could be deescalated based on ctDNA clearance and other pathological markers.  

Dr. Serzan said he continues to treat patients with adjuvant durvalumab based on the NIAGARA data, regardless of ctDNA status, although his decision depends on each patient’s surgical recovery and treatment tolerance.  

In addition, he emphasized that treatment goals differ between patients who are treated with curative intent and patients with metastatic disease, two factors that can often shape treatment discussion.