ESMO: Imfinzi–Padcev shows promise with less Padcev after surgery

At ESMO 2026, results from the phase 3 VOLGA trial suggested that a shorter course of Padcev may be enough when paired with Imfinzi for some people with muscle-invasive bladder cancer (MIBC).

The trial enrolled 695 patients whose MIBC could not be treated with cisplatin-based chemotherapy, or who declined it. The Imfinzi–Padcev group received three cycles of Padcev before surgery, followed by Imfinzi after surgery; it did not receive Padcev after surgery.

Compared with the trial’s standard-care control, the regimen reduced the risk of an event—disease progression or recurrence, not reaching surgery, or death—by 49% (hazard ratio 0.51). At two years, 64% of patients were event-free, compared with 45% in the control group.

The reported reduction in risk of death was 42% (hazard ratio 0.58); the estimated two-year overall-survival rates were 78% with the combination and 69% with control.

Adding AstraZeneca’s Imjudo (tremelimumab) did not appear to add benefit. The approach may spare patients additional Padcev after surgery, but it has not been shown to be equivalent or superior to other regimens in a head-to-head trial.

The comparisons with Keytruda–Padcev are across separate trials, so differences in results should not be treated as proof that one combination is better. The findings are promising, but treatment choice and regulatory status depend on clinical guidance and approvals.