Dr. Bogdana Schmidt

But I definitely want to get your thoughts on where you think the field is heading and what you'll be looking forward to in future meetings. So with that in mind, let's jump into the Niagara trial presented to Dr. Tom Powell's.

So let's talk a little bit about the details of Niagara. So like you said, it's neoadjuvant cisplatin-based chemo with perioptervalumab addition. So these are patients who got dervalumab before and after.

So let's talk a little bit about the details of Niagara. So like you said, it's neoadjuvant cisplatin-based chemo with perioptervalumab addition. So these are patients who got dervalumab before and after.

So let's talk a little bit about the details of Niagara. So like you said, it's neoadjuvant cisplatin-based chemo with perioptervalumab addition. So these are patients who got dervalumab before and after.

One of the things that I thought was interesting here, and I want to see what you think about that, as you mentioned on it about cisplatin versus carboplatin, is patients were able to receive cisplatin with a creatinine clearance of down to 40%. Is that your typical practice? Are you seeing patients going to split dose at 40, or do you generally cut off patients at 50?

One of the things that I thought was interesting here, and I want to see what you think about that, as you mentioned on it about cisplatin versus carboplatin, is patients were able to receive cisplatin with a creatinine clearance of down to 40%. Is that your typical practice? Are you seeing patients going to split dose at 40, or do you generally cut off patients at 50?

One of the things that I thought was interesting here, and I want to see what you think about that, as you mentioned on it about cisplatin versus carboplatin, is patients were able to receive cisplatin with a creatinine clearance of down to 40%. Is that your typical practice? Are you seeing patients going to split dose at 40, or do you generally cut off patients at 50?

One other thing I wanted to highlight for this trial, and maybe we'll come back to that as well, is the patient population here. So we looked at patients that were T2 to T4, N0 and N1. So there were some node positive patients here. And of course, in the comparator arm, patients were randomized to get just GEMSYS and radical cystectomy, didn't get any adjuvant treatment.

One other thing I wanted to highlight for this trial, and maybe we'll come back to that as well, is the patient population here. So we looked at patients that were T2 to T4, N0 and N1. So there were some node positive patients here. And of course, in the comparator arm, patients were randomized to get just GEMSYS and radical cystectomy, didn't get any adjuvant treatment.

One other thing I wanted to highlight for this trial, and maybe we'll come back to that as well, is the patient population here. So we looked at patients that were T2 to T4, N0 and N1. So there were some node positive patients here. And of course, in the comparator arm, patients were randomized to get just GEMSYS and radical cystectomy, didn't get any adjuvant treatment.

Looking at this trial, if you were designing it today, what would you have included or tried to do differently? Knowing, obviously, this trial was enrolling when I was a fellow, so five years ago, so I know we didn't have a ton of the data that we have now.

Looking at this trial, if you were designing it today, what would you have included or tried to do differently? Knowing, obviously, this trial was enrolling when I was a fellow, so five years ago, so I know we didn't have a ton of the data that we have now.

Looking at this trial, if you were designing it today, what would you have included or tried to do differently? Knowing, obviously, this trial was enrolling when I was a fellow, so five years ago, so I know we didn't have a ton of the data that we have now.

But given the groupings, given the decisions that were made in the standard of care arms, if you were redesigning it, how would you do it differently now?

But given the groupings, given the decisions that were made in the standard of care arms, if you were redesigning it, how would you do it differently now?

But given the groupings, given the decisions that were made in the standard of care arms, if you were redesigning it, how would you do it differently now?

Yes, which we'll get to in a minute.

Yes, which we'll get to in a minute.

Yes, which we'll get to in a minute.

I agree. And I do want to get back to your point. I think that's a really important point of path CR as an outcome here, because that is tricky, right? We know that even from old trials, SWOG trial, Nordic, et cetera, that when we were looking at neoadjuvant chemo in this setting, there is a PT0 rate from TUR alone, meaning no neoadjuvant treatment whatsoever, in the 12% to 15% range.