🚨 VOLGA is positive! But how much perioperative EV do we really need in MIBC? Interesting comparison with KEYNOTE-905 at #ESMO26: 🔹 VOLGA (EV + durvalumab): 2-year EFS 64%, OS 78%, pCR 45%. EFS HR 0.51. 🔹 KEYNOTE-905 (EV + pembrolizumab): 2-year EFS 74.7%, OS 79.7%, pCR 57.1%. EFS HR 0.40. Numerically lower EFS and pCR in VOLGA. Why? Different patient populations and tumor characteristics? Different study designs? It seems premature to attribute these differences to pembrolizumab vs durvalumab. But the most intriguing question is how much benefit does adjuvant EV actually add? VOLGA achieved a significant OS benefit with just 3 neoadjuvant EV cycles and NO adjuvant EV, whereas KEYNOTE-905 planned 9 EV cycles (3 neoadjuvant + 6 adjuvant)—and fewer than half of patients reportedly completed the full planned EV course. Could pCR and ctDNA clearance help us safely omit adjuvant EV and reduce cumulative toxicity? ⚠️ Cross-trial comparisons are hypothesis-generating, not evidence of superiority or equivalence. Only prospective trials can establish the incremental benefit of adjuvant EV. More EV ≠ necessarily better outcomes. Let’s identify who really needs it! 🔬 @OncoAlert @weoncologists @tompowles1 @urotoday @Uromigos @OncoAlert Faculty @DrChoueiri , @tompowles1 , @apolo_andrea , @neerajaiims , @montypal , @Silke_Gillessen , @AOmlin , @brian_rini , @PGrivasMDPhD , @TiansterZhang , @amerseburger , @DrDanielHeng , @HHammersMD , @scocmem , @AndreaNecchi , @AmandaNizamMD , @drenriquegrande , @nataliagandur , @AlbigesL , @cdanicas , @declangmurphy , @seanmmcbride , @shilpaonc , @DrRanaMcKay , @scserendipity1 , @DrYukselUrun , @ravikanesvaran , @BraunMDPhD , @EfstathiouEleni , @mzugman , @crisbergerot @Markuseckstein3