A 72-year-old man undergoes radical cystectomy for muscle-invasive bladder cancer (pT3bN1M0). He receives cisplatin-based neoadjuvant chemotherapy (MVAC regimen). Pathology shows complete pathological response (pT0N0). According to CheckMate 274 trial, what adjuvant therapy has demonstrated improved disease-free survival in this setting?
- A Adjuvant pembrolizumab for 1 year
- B Adjuvant atezolizumab for 1 year
- C Adjuvant nivolumab for 1 year ✓
- D No adjuvant therapy; observation only
Explanation
The CheckMate 274 trial demonstrated that adjuvant nivolumab (PD-1 inhibitor) for 1 year after radical cystectomy significantly improved disease-free survival compared to placebo in high-risk muscle-invasive urothelial carcinoma (pT3/4 or node-positive), including patients who received prior neoadjuvant chemotherapy. The benefit was particularly pronounced in patients with high PD-L1 expression (≥1% tumor cells). This led to FDA approval of adjuvant nivolumab. JAVELIN Bladder 100 (avelumab) demonstrated benefit as maintenance therapy in metastatic disease. IMvigor010 (atezolizumab) failed to show DFS benefit in adjuvant setting.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.