Practice-Changing Insights From the NIAGARA Trial

Petros Grivas, MD, PhD Fred Hutchinson Cancer Center, UW Medicine

Key Points

• NIAGARA trial: How its findings impact National Comprehensive Cancer Network guidelines for the treatment of muscle-invasive bladder cancer (MIBC).

• Exploring when and how durvalumab can be used in the community oncology setting among patients with MIBC.

• Panel discussion on cisplatin eligibility and level 1 evidence supporting perioperative durvalumab.

At the 2025 American Society of Clinical Oncology Annual Meeting, a panel of experts led by Rahul Gosain, MD, MBA, and Rohit Gosain, MD, discussed the pivotal findings of the NIAGARA trial and their implications for community oncology practices.  

The phase 3 study demonstrated a 32% reduction in the risk of recurrence and a 25% reduction in the risk of death in patients with muscle-invasive bladder cancer (MIBC) who received durvalumab plus neoadjuvant gemcitabine and cisplatin, followed by durvalumab as adjuvant monotherapy after radical cystectomy, compared with neoadjuvant chemotherapy alone.  

Based on this level 1 evidence, the National Comprehensive Cancer Network updated its Clinical Practice Guidelines in February 2025 to recommend perioperative treatment with durvalumab, neoadjuvant cisplatin-based chemotherapy, and cystectomy for eligible patients with MIBC.  

Joining the Oncology Brothers, Petros Grivas, MD, PhD, of Fred Hutchinson Cancer Center and UW Medicine, Seattle, Washington, discussed the clinical implications in the community oncology setting and his preferences for cisplatin-eligible patients.