Romain Boissier

#EAU26 London – Take-Home Messages on Muscle-Invasive and Advanced Urothelial Cancer 🫵 Honoured to be part of the scientific committee office of the congress and to  share today at the hashtag#EAU26 in London a short “Best of the Best” overview of the most impactful data shaping the management of muscle-invasive bladder cancer (MIBC) and metastatic urothelial carcinoma. Here are my key take-home messages: 1️⃣ Radical cystectomy remains central in MIBC (in 2026) Despite the rapid development of systemic therapies and bladder-preserving strategies, radical cystectomy continues to be the cornerstone of curative treatment. Current diagnostic tools (imaging, endoscopy) still lack the accuracy needed to safely omit surgery in most patients. 2️⃣ Biomarkers are coming – but not ready to replace surgery Circulating tumor DNA (ctDNA) is emerging as a powerful tool to identify minimal residual disease and systemic relapse risk. However, ctDNA currently reflects systemic disease rather than local bladder tumor burden. We are not yet able to confidently equate clinical complete response with pathological complete response. 3️⃣ EV + Pembrolizumab is reshaping the peri-operative landscape Results from KEYNOTE-B15 / EV-304 and KEYNOTE-905 / EV-303 suggest that ADC + immune checkpoint inhibitor combinations may significantly improve outcomes compared with standard cisplatin-based chemotherapy. But an essential message remains: ➡️ Systemic therapy must be integrated with radical cystectomy, not replace it. 4️⃣ In metastatic urothelial cancer: EV + Pembro is the new frontline standard Data continue to confirm that enfortumab vedotin + pembrolizumab provides major improvements in PFS and OS versus platinum chemotherapy. ➡️ The paradigm has shifted: EVP first – ask questions later. 5️⃣ The next challenges • Optimising toxicity management of EVP • Identifying patients with early progression • Integrating biomarkers and real-world evidence • Defining the future role of chemotherapy in a rapidly evolving landscape Exciting times in urothelial cancer, where surgery, systemic therapy, biomarkers and innovation are finally converging. #EAU26 #BladderCancer #UrothelialCancer #MIBC #Oncology #Urology @Uroweb @AFUrologie

At @myESMO #esmo2025 Berlin, I had the privilege to present the #ALBAN trial (GETUG–AFU 37), an academic phase III study led by @AFUrologie & @GETUG_Unicancer @LaCarine1 together with my outstanding co-PI @y_loriot ,co-investigators @PignotG @champiatMD @PrRomainMATHIEU @ThoSeisen @laconss @UrologieParis and many others across 🇫🇷🇧🇪🇪🇸. Atezolizumab + BCG did not improve EFS vs BCG alone (HR 0.98; 95% CI 0.71–1.36). The result was negative across all subgroups, including CIS. Higher ≥G3 TRAEs were observed in the combination arm. These findings highlight that in localized #BladderCancer, systemic toxicity assessment remains a key endpoint to balance benefit and risk. Proud of this collective academic journey started in 2017 — despite the global BCG shortage and COVID-19 — and now published in @Annals_Oncology 📄 doi.org/10.1016/j.annonc.202… with the financial support of @Roche #NMIBC #ESMO25 #OncoUrology #ClinicalResearch @AFUrologie @afufuro @GETUG_Unicancer #EAUguidelines @Uroweb @AmerUrological @ASCO @Uromigos @tompowles1 @DrChoueiri