Most of us think of chemotherapy as a given once cancer turns aggressive. But not everyone can tolerate it. For many people with bladder cancer, the standard chemo is simply out of reach.
Now a large international trial has given that group something new. Patients who received a two-drug combination before and after surgery had a 42% lower risk of dying than patients who had surgery alone.
The results were published in the New England Journal of Medicine in November 2026. The phase 3 trial, called VOLGA, enrolled 695 patients at 229 medical centers across 25 countries.
All of them had muscle-invasive bladder cancer, the aggressive form that has grown into the bladder's muscle layer. None could tolerate or wanted cisplatin, the chemotherapy drug that has long been the standard first step.
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How the combination worked
The drugs were durvalumab, an immunotherapy sold as Imfinzi by AstraZeneca, and enfortumab vedotin, a targeted cancer drug sold as Padcev by Pfizer and Astellas. Patients received the pair before surgery to shrink the tumor. Durvalumab then continued on its own afterward.
At the two-year mark, 78.4% of patients on the combination were still alive, according to the ASCO Post. In the surgery-only group, 69.4% survived that long.
The risk of the cancer coming back, progressing or the patient dying fell by 49% in the combination group. Nearly half of those patients had no detectable cancer left when they went in for surgery. In the surgery-only group, that figure was less than one in ten.
Why it matters for so many patients
Bladder cancer is one of the most common cancers in the United States. The American Cancer Society projects about 84,530 new cases in 2026, and roughly a quarter of patients already have the muscle-invasive form when they are first diagnosed.
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For that group, cisplatin-based chemotherapy before surgery has long been the standard. But nearly half of patients cannot take cisplatin because of kidney problems, hearing loss, heart disease or poor general health.
They have often gone straight to surgery with no pre-treatment, which raises the risk of the cancer returning.
The trial was co-led by Dr. Alexandra Drakaki of UCLA Health Jonsson Comprehensive Cancer Center.
According to her team, this large group of patients has been left with limited treatment options for years, and the new regimen gives them an effective pre-surgery alternative for the first time.
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The researchers also tested a three-drug version that added a second immunotherapy called tremelimumab. That arm reduced recurrences too, but did not show a statistically significant benefit on overall survival.
Anyone with blood in the urine, frequent painful urination or other warning signs of bladder trouble should still see a doctor promptly.
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This article is made and published by Mie Hermansen, who may have used AI in the preparation.