ESMO 2026: immunotherapy combo shows promising results in muscle-invasive bladder cancer

For people with muscle-invasive bladder cancer, treatment often involves surgery to remove the bladder. New research presented at the 2026 European Society for Medical Oncology (ESMO) Congress suggests that combining surgery with medications before and after the operation may help more people live longer and reduce the risk of their cancer returning.

The phase 3 VOLGA trial found that people who received durvalumab (Imfinzi) and enfortumab vedotin (Padcev) alongside surgery had better outcomes than those who had surgery alone. The findings are especially important for people who can’t receive or choose not to receive cisplatin-based chemotherapy, a commonly used treatment for bladder cancer.

What did the VOLGA trial find?

The study compared surgery alone with two treatment combinations. One group received durvalumab and enfortumab vedotin before surgery, followed by durvalumab after surgery. A second group received the same treatment, plus a third drug called tremelimumab.

After two years, 63.5% of patients who received durvalumab and enfortumab vedotin were alive without their cancer returning or another major disease-related event, compared with 45.1% of patients who had surgery alone. This means more patients in the treatment group went through the first two years without experiencing a major setback related to their cancer.

The combination also improved overall survival. At two years, 78.4% of patients who received durvalumab and enfortumab vedotin were alive, compared with 69.4% of those who had surgery alone.

Why do these findings matter for patients?

Until recently, treatment options for muscle-invasive bladder cancer were more limited, and many people faced a significant risk of their cancer returning after surgery. Research over the past few years has helped change this, showing that adding medications around the time of surgery can improve outcomes.

The VOLGA findings add to this progress by identifying another potential treatment approach for people who can’t receive or choose not to receive cisplatin-based chemotherapy. This matters because not everyone can tolerate the same treatments, and having more options may help patients and their care teams find an approach that fits their needs.

Does adding a third drug help?

The trial also looked at whether adding tremelimumab to durvalumab and enfortumab vedotin could further improve results. Although the three-drug combination improved the time patients lived without a major disease-related event compared with surgery alone, it didn’t show a statistically significant improvement in overall survival at the time of this analysis.

The three-drug combination also caused more serious side effects. Severe side effects occurred in 79.5% of patients receiving all three drugs, compared with 71.1% of those receiving the two-drug combination.

These results suggest that adding more medications doesn’t always lead to better outcomes. Finding the right balance between effective treatment and side effects remains an important part of bladder cancer research.

The bottom line

The VOLGA trial adds to growing evidence that combining medications with surgery can improve outcomes for people with muscle-invasive bladder cancer. While more research and follow-up will help clarify the long-term benefits and risks, these findings offer hope for patients who have limited chemotherapy options. If you’re facing bladder cancer surgery, ask your care team whether treatments before or after surgery could be appropriate for you.

Disclaimer: The information provided in this article is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Outcomes4Me is not acting as your caregiver, and any suggestions or guidance offered should not replace the advice of your healthcare provider or qualified medical professional. Always seek the guidance of your physician or other qualified health provider with any questions you may have regarding a medical condition.