FDA expanded Anktiva plus BCG to BCG-unresponsive high-grade papillary-only NMIBC by extrapolation from CIS data, the ZZ-FIRST talazoparib-enzalutamide phase 2 in high-volume mHNPC published in Nature Medicine without clear added benefit, updated LUNAR and a JAMA Oncology neoadjuvant SAbR trial for RCC with IVC thrombus both reported, and ESMO26 GU previews dominated the week.
๐ Publications
๐ฆ Twitter / ๐ฆ Bluesky
Full details below โ
Talazoparib plus enzalutamide in high-volume metastatic hormone-naive prostate cancer: a randomized phase 2 trial. โ Zacchi Francesca et al., Nat Med
Fifty-four patients starting androgen deprivation therapy received two cycles of enzalutamide lead-in, then were randomized 1:2 to enzalutamide (n = 17) or enzalutamide plus talazoparib (n = 37). The primary endpoint was met: the PSA <0.2 ng/ml response rate at 12 months was 73% in the combination arm (95% CI = 56-86%, P < 0.001 against the prespecified threshold), compared with 64.7% in the control arm (95% CI = 38-86%, P = 0.54 for the exploratory between-arm comparison). Grade โฅ3 adverse events occurred in 68% with the combination versus 35% with enzalutamide alone, predominantly anemia (41%). Two fatal therapy-emergent myeloid neoplasms occurred in the combination arm in patients with underlying genomic susceptibility. Paired biopsies showed suppression of HRR-related gene expression after AR inhibition without functional impairment of homologous recombination.
Clinical bottom line: In biomarker-unselected high-volume metastatic hormone-naive prostate cancer, adding talazoparib to enzalutamide added toxicity, including two fatal myeloid neoplasms, without clear benefit over enzalutamide alone. The combination should stay out of practice outside molecularly selected populations.
Neoadjuvant Stereotactic Ablative Radiotherapy Before Inferior Vena Cava Thrombectomy for Renal Cell Carcinoma: A Phase 2 Nonrandomized Clinical Trial. โ Hannan Raquibul et al., JAMA Oncol
Patients with RCC and Mayo level II to IV IVC tumor thrombus received SABR to the thrombus, delivered as 40 Gy in 5 fractions or 36 Gy in 3 fractions, before radical nephrectomy and IVC thrombectomy. Of 23 patients treated, 22 completed surgery and 21 were analyzed. One-year RFS was 71.4% (80% CI, 56.6-82.0; 95% CI, 47.2-86.0), which met the screening criterion against a historical surgery-alone benchmark of 55.7% (P = .09). One-year overall survival was 95.2%. There was no 90-day perioperative mortality, and 4 grade 4 treatment-attributed events occurred, with no grade 4/5 radiation-attributed toxic effects.
Clinical bottom line: Neoadjuvant SABR to IVC tumor thrombus is feasible and safe in this single-center phase 2. With only 21 analyzable patients and a historical control, it does not change surgical practice today for RCC with venous thrombus.
๐ Every paper considered this week, including the ones that didnโt make it โ
How these are chosen: filtered for clinical relevance, grouped by the new development discussed, then ordered by engagement (bookmarks and reposts).
FDA expanded Anktiva (nogapendekin alfa inbakicept-pmln) with BCG to BCG-unresponsive high-grade papillary-only NMIBC, the first approval specifically for this group. The FDA concluded that efficacy shown in CIS-containing disease could be extrapolated to papillary disease based on overlapping features. Clinicians flagged the nuance: the complete response figure comes from CIS patients, and both cohorts came from the same single-arm trial without a randomized papillary-only comparison. The open question is whether that extrapolation is enough to choose Anktiva plus BCG over cystectomy or a competing intravesical agent.
Key numbers: CIS cohort CR 62% ยท Responders durable โฅ2 yr 40% ยท Papillary-only 1-yr disease-free 58%
Discussed by: @phsiao4, @ilyassahinMD, @VivekSubbiah, @ozdogan_md, @PGrivasMDPhD
Sources cited: FDA press release ยท FDA press release ยท Cancer Network
Four randomized phase III perioperative bladder trials are at ESMO26: VOLGA, KEYNOTE-866, ENERGIZE and KEYNOTE-905. ctDNA data from KEYNOTE-B15/EV-304 will also be presented, while no personalized cancer vaccine or RT +/- ICI data are on the program. VOLGA has a positive EFS/OS press-release topline for durvalumab plus EV, but the magnitude, surgical outcomes and toxicity are still awaited. Clinicians ask whether VOLGA's shorter EV exposure matches perioperative EVP, where longer EV gave an OS HR of 0.5-0.6, and whether ENERGIZE and KEYNOTE-866 reproduce NIAGARA's OS HR of 0.75 or show antagonism with platinum. The underlying trade-off is whether post-op EV can be omitted for a less toxic paradigm; as one clinician cautioned, identifying a favorable-risk group by ctDNA is different from proving treatment can be safely reduced.
Discussed by: @Uromigos, @OncoAlert, @PGrivasMDPhD, @DCockrellMD
Following FDA approval of EV-pembrolizumab for cisplatin-ineligible resectable MIBC based on KEYNOTE-B15/EV-304, CHMP adopted a positive opinion recommending the regimen as neoadjuvant therapy. The trial improved EFS, OS and pathologic complete response, with rash and neuropathy the notable adverse events. The practical debate centers on patients with minimal response to neoadjuvant EV-pembro: should adjuvant therapy continue the same regimen or switch to chemotherapy?
Key numbers: 2-yr EFS 79.4% vs 66.2%, HR 0.53 ยท 2-yr OS 86.9% vs 81.3%, HR 0.65 ยท pCR 55.8% vs 32.5%
Discussed by: @OncBrothers, @OncBrothers, @DCockrellMD
Sources cited: OncLive
A multi-institutional study of 739 KEYNOTE-564-eligible patients suggests that adjuvant pembrolizumab benefit in clear cell RCC may scale with baseline recurrence risk, although the interaction was not significant. Final OS for KEYNOTE-564 is among the ESMO26 renal highlights. Clinicians are weighing whether to reserve adjuvant pembrolizumab for the highest-risk patients, or whether a non-significant interaction means it should still be offered to all eligible patients.
The phase II LUNAR trial tested 177Lu-PNT2002 before SBRT in oligorecurrent hormone-sensitive prostate cancer. Among 92 randomized patients, median PFS improved from 7.4 to 17.6 months. At a median follow-up of 32 months, exploratory analyses show improvement in polymetastatic PFS, castrate disease-free survival and CT-based PFS. The debate is whether the PFS gain justifies use now, or whether castrate disease-free survival should first be confirmed outside exploratory analysis.
Discussed by: @jryckman3, @OncoAlert, @AuntMinnie
Sources cited: 177 Lu-Prostate-Specific Membrane Antigen Neoadjuvant to Stereotactic Ablative Radiotheraโฆ (Journal of Clinical Oncology, 2025) ยท ScienceDirect
ZZ-FIRST, an academic randomized phase II trial with spatial transcriptomics on longitudinal biopsies, met its PSA response endpoint in the combination arm, but superiority over enzalutamide alone was not established. Commentators noted no significant rPFS/OS benefit, greater toxicity including two fatal cases of AML, and the small size of the trial (n=54). Tumor analyses showed that AR inhibition altered gene expression without impairing functional homologous recombination in this biomarker-unselected population. Clinicians argue for molecular selection over indiscriminate intensification, which raises the question of whether PARP inhibitor plus ARPI combinations should be restricted to HRR-altered patients.
Key numbers: 12-mo PSA <0.2 73% vs 64.7%, P = 0.54 ยท Grade โฅ3 AEs 68% vs 35% ยท Grade โฅ3 anemia 41%
Discussed by: @aftimosp, @OncoAlert, @OncoAlert
Sources cited: Talazoparib plus enzalutamide in high-volume metastatic hormone-naive prostate cancer: aโฆ (Nat Med)
A press release reports that the frontline triplet comparison of lenvatinib/pembrolizumab/belzutifan versus lenvatinib/pembrolizumab/CTLA4 versus lenvatinib/pembrolizumab is negative. LITESPARK-012 also missed its PFS/OS endpoints when belzutifan was added to frontline pembrolizumab/lenvatinib. In contrast, LITESPARK-011 improved PFS with belzutifan plus lenvatinib versus cabozantinib after IO, leading to September FDA approval, though final OS was not significant. ESMO will add QoL analyses and prior-treatment subgroups, which may help locate where HIF-2alpha inhibition adds value given anemia/hypoxia and TKI toxicity.
Key numbers: LITESPARK-011 PFS 14.8 vs 10.7 mo, HR 0.70 ยท Final OS HR 0.85
Discussed by: @Uromigos, @DCockrellMD
A health-system-scale cachexia atlas of 52K patients, published in Nature Medicine, describes and predicts outcomes and provides prospective risk models for lung, colorectal and prostate cancer. The question for clinicians is whether such a model should change how men with advanced prostate cancer are screened and supported.
Discussed by: @EladSharonMD, @MarcusDGon
Sources cited: A health-system-scale, episode-resolved multimodal atlas of cancer cachexia (Nature Medicine, 2026)
Vivek Subbiah, MD @VivekSubbiah
TheโฏU.S. Food and Drug Administration today expanded the approved use of Anktiva (nogapendekin alfa inbakicept-pmln), given with Bacillus Calmette-Guรฉrin (BCG), to include adults with high-grade papillary-only bladder cancer that has not spread into the bladder muscle and hasโฏnot responded to BCG treatment. Anktiva is the first FDA-approved treatment specifically for patients with BCG-unresponsive, high-grade papillary-only disease https://t.co/qRSnF5LGbp
๐ 0 โค๏ธ 14 ๐ 6 ๐ 1,498
OncoAlert @OncoAlert
๐ฅ New @GuardConsortium Educational Capsule
Dr. Joaquin Mateo @quimmateo of @VHIO in Barcelona ๐ช๐ธ breaks down TALAPRO-3, Presented at ASCO 2026 and published on the NEJM with @AzadOncology @neerajaiims and others
TALAPRO-3 is the first phase 3 trial of a PARP inhibitor plus ARPI in HRR-altered metastatic hormone-sensitive (APMS) prostate cancer.
๐น N=599, talazoparib + enzalutamide vs placebo + enzalutamide
๐น 3-yr rPFS: 77% vs 56% (HR 0.48; 95% CI 0.36โ0.65; p<0.001)
๐น Interim OS at 3 yrs: 78% vs 72% (HR 0.77; 95% CI 0.56โ1.04), still immature
๐น Grade โฅ3 anemia in 51% of the talazoparib arm
https://t.co/kNTS4yojcB
Does this move PARPi into the hormone-sensitive setting? Watch ๐
@DrFelixGuerrero, @cdanicas, @dralvaropinto, @drenriquegrande, @fcounago, @docjavip, @BerUrologia,@DrJaVallejo, @Maroto5Pablo, @nachoduranm, @RodriguezAntona, @AnaPlatabello1, @Uro_Oncologist,@Ecastromarcos, @abraocantoMD, @AlvarezMa89031, @OncBrothers, @Helena_de_Palma, ,@DrIacovelli, @mjuanfi81,
Pinging our OncoALert faculty
@montypal, @crisbergerot, @DrDanielHeng, @apolo_andrea, @DrChoueiri,@PGrivasMDPhD, @TiansterZhang, @HHammersMD, @ravikanesvaran, @amerseburger,@sonpavde, @scserendipity1, @Silke_Gillessen, @EfstathiouEleni, @BraunMDPhD,@nataliagandur,@brian_rini, @AOmlin, @realbowtiedoc, @AmandaNizamMD , @AndreaNecchi, @scocmem
๐ 0 โค๏ธ 24 ๐ 11 ๐ 1,775
Oncology Brothers @OncBrothers
RT @OncoAlert: ๐ฅ New @GuardConsortium Educational Capsule
Dr. Joaquin Mateo @quimmateo of @VHIO in Barcelona ๐ช๐ธ breaks down TALAPRO-3, Presented at ASCO 2026 and published on the NEJM with @AzadOncology @neerajaiims and others
TALAPRO-3 is the first phase 3 trial of a PARP inhibitor plus ARPI in HRR-altered metastatic hormone-sensitive (APMS) prostate cancer.
๐น N=599, talazoparib + enzalutamide vs placebo + enzalutamide
๐น 3-yr rPFS: 77% vs 56% (HR 0.48; 95% CI 0.36โ0.65; p<0.001)
๐น Interim OS at 3 yrs: 78% vs 72% (HR 0.77; 95% CI 0.56โ1.04), still immature
๐น Grade โฅ3 anemia in 51% of the talazoparib arm
https://t.co/kNTS4yojcB
Does this move PARPi into the hormone-sensitive setting? Watch ๐
@DrFelixGuerrero, @cdanicas, @dralvaropinto, @drenriquegrande, @fcounago, @docjavip, @BerUrologia,@DrJaVallejo, @Maroto5Pablo, @nachoduranm, @RodriguezAntona, @AnaPlatabello1, @Uro_Oncologist,@Ecastromarcos, @abraocantoMD, @AlvarezMa89031, @OncBrothers, @Helena_de_Palma, ,@DrIacovelli, @mjuanfi81,
Pinging our OncoALert faculty
@montypal, @crisbergerot, @DrDanielHeng, @apolo_andrea, @DrChoueiri,@PGrivasMDPhD, @TiansterZhang, @HHammersMD, @ravikanesvaran, @amerseburger,@sonpavde, @scserendipity1, @Silke_Gillessen, @EfstathiouEleni, @BraunMDPhD,@nataliagandur,@brian_rini, @AOmlin, @realbowtiedoc, @AmandaNizamMD , @AndreaNecchi, @scocmem
๐ 0 โค๏ธ 24 ๐ 11 ๐ 1,775
CancerNetworkยฎ @CancerNetwrk
The FDA has expanded the approval of nogapendekin alfa inbakicept-pmln with BCG for BCG-unresponsive non-muscle invasive bladder cancer to include patients with high-grade papillary-only tumors.
Based on the overlapping features of high-grade papillary and carcinoma in situ tumors, the FDA concluded that the prior demonstration of efficacy in disease containing CIS could be extrapolated to BCG-unresponsive high-grade papillary disease.
Read more โก๏ธ https://t.co/7pH6lGWUSS
#blcsm #NMIBC #BladderCancer #oncology | @FDA
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Gil Morgan, MD @weoncologists
New GUARD Educational Capsule: @quimmateo breaks down TALAPRO-3 (@NEJM) #ProstateCancer
Talazoparib + enzalutamide in HRR+ mHSPC: 3-yr rPFS 77% vs 56% (HR 0.48), OS maturing
Congrats to the TALAPRO-3 team ๐ @AzadOncology ,my amazing friend @neerajaiims and many others!
Is HRR testing at diagnosis routine for you yet?
@VJOncology @high5md @COR2EDMedEd @APCCC_Lugano @mirrorsmed @Uromigos
[Quoting @OncoAlert: ๐ฅ New @GuardConsortium Educational Capsule
Dr. Joaquin Mateo @quimmateo of @VHIO in Barcelona ๐ช๐ธ breaks down TALAPRO-3, Presented at ASCO 2026 and published on the NEJM with @AzadOncology @neerajaiims and others
TALAPRO-3 is the first phase 3 trial of a PARP inhibitor plus ARPI in HRR-altered metastatic hormone-sensitive (APMS) prostate cancer.
๐น N=599, talazoparib + enzalutamide vs placebo + enzalutamide
๐น 3-yr rPFS: 77% vs 56% (HR 0.48; 95% CI 0.36โ0.65; p<0.001)
๐น Interim OS at 3 yrs: 78% vs 72% (HR 0.77; 95% CI 0.56โ1.04), still immature
๐น Grade โฅ3 anemia in 51% of the talazoparib arm
https://t.co/kNTS4yojcB
Does this move PARPi into the hormone-sensitive setting? Watch ๐
@DrFelixGuerrero, @cdanicas, @dralvaropinto, @drenriquegrande, @fcounago, @docjavip, @BerUrologia,@DrJaVallejo, @Maroto5Pablo, @nachoduranm, @RodriguezAntona, @AnaPlatabello1, @Uro_Oncologist,@Ecastromarcos, @abraocantoMD, @AlvarezMa89031, @OncBrothers, @Helena_de_Palma, ,@DrIacovelli, @mjuanfi81,
Pinging our OncoALert faculty
@montypal, @crisbergerot, @DrDanielHeng, @apolo_andrea, @DrChoueiri,@PGrivasMDPhD, @TiansterZhang, @HHammersMD, @ravikanesvaran, @amerseburger,@sonpavde, @scserendipity1, @Silke_Gillessen, @EfstathiouEleni, @BraunMDPhD,@nataliagandur,@brian_rini, @AOmlin, @realbowtiedoc, @AmandaNizamMD , @AndreaNecchi, @scocmem]
๐ 1 โค๏ธ 8 ๐ 5 ๐ 759
The ASCO Post @ASCOPost
๐จ #FDAApproval: The @FDA has granted approval for expanded indication for Anktiva + BCG in BCG-unresponsive #NMIBC to include adults with high-grade papillary-only tumors.
๐ https://t.co/skQepeRqHp https://t.co/qr5tvoyjlZ
๐ 1 โค๏ธ 3 ๐ 3 ๐ 786
UroToday.com @urotoday
#PSMAddition trial results and the novel APMS indication for Pluvictoยฎ. @DrScottTagawa @WeillCornell, Gordon Brown, DO, FACOS & Neal Shore, MD, FACS @CURCMB joins @PhillipKooMD @PCFnews to discuss the PSMAddition FDA approval of lutetium-177 PSMA-617 added to ADT plus ARPI in metastatic androgen pathway modulation-naive or sensitive disease. #WatchNow > https://t.co/H1MNLScP8R
๐ 1 โค๏ธ 5 ๐ 4 ๐ 685
UroToday.com @urotoday
Pluvictoยฎ approval in androgen pathway modulator naive #ProstateCancer and the origins of #PSMAddition. Michael Morris, MD @MSKCancerCenter joins @sartor_oliver @EJHospital discussing the origins and clinical implications of PSMAddition. The study returned an rPFS hazard ratio of 0.72 for lutetium-177 PSMA-617 added to an ADT plus ARPI doublet. Dr. Morris views lutetium as a clearer intensification option than docetaxel; no controlled trial has established docetaxel's benefit when added to an ADT plus ARPI backbone. #WatchNow > https://t.co/JyBJzgQ0Iz
๐ 1 โค๏ธ 6 ๐ 6 ๐ 1,038
ilyas sahin, MD @ilyassahinMD
FDA expands Anktiva + BCG approval for BCG-unresponsive non-muscle-invasive bladder cancer to include high-grade papillary-only tumors. Previously, the indication required CIS (carcinoma in situ).
Original CIS cohort (n=77): 62% complete response, with 40% of responders maintaining their response for at least 2 years.
Papillary-only cohort (n=80): 58% disease-free at 1 year.
Both cohorts came from the same single-arm trial, with no randomized comparison. The expansion relied on existing data plus the biological overlap between CIS and papillary disease. So, another option to preserve the bladder.
https://t.co/7UhwX965fj
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OncLive.com @OncLive
๐จBREAKING๐จ
The @FDA has approved nogapendekin alfa inbakicept-pmln in combination with BCG for the treatment of adult patients with BCG-unresponsive NMIBC with high-grade papillary-only tumors.
Full details ๐: https://t.co/BoAIcBsbY7
#blcsm #oncology https://t.co/X425277OSL
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OncLive.com @OncLive
๐ช๐บ CHMP has recently adopted a positive opinion recommending the approval of pembrolizumab plus enfortumab vedotin as neoadjuvant therapy for MIBC based on findings from the phase 3 KEYNOTE-B15/EV-304 trial
Read more here โก๏ธ: https://t.co/gc9oHYwAKE
#blcsm #oncology
๐ 0 โค๏ธ 6 ๐ 2 ๐ 1,197
Paul H, PharmD, RPH @phsiao4
FDA approves an expanded indication for nogapendekin alfa inbakicept-pmln for BCG-unresponsive non-muscle invasive bladder cancer
nogapendekin alfa inbakicept-pmln (Anktiva) https://t.co/3jTerKmGbv
๐ 0 โค๏ธ 1 ๐ 0 ๐ 462
Paul H, PharmD, RPH @phsiao4
RT @FDADrugs: Big news for bladder cancer patients! FDA just expanded approval of Anktiva with BCG for adults with BCG-unresponsive, high-grade papillary-only NMIBC โ the first treatment approved for this group. This is a first, and that matters. Evidence from a closely related form of bladder cancer supported the approval.
https://t.co/azWUTpNxjm
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HemOnc Today @HemOncToday
๐จ Breaking news ๐จ
@US_FDA expands approval of #Anktiva @AltorBioCorp @ImmunityBio.
The agent is the first approved treatment for #BCG-unresponsive, high-grade papillary-only #BladderCancer. https://t.co/YGmgyqY9gl
๐ 1 โค๏ธ 6 ๐ 0 ๐ 211
Weekly Reviewer @ReviewingNews
FDA expanded Anktiva to papillary-only bladder cancer
#FDA #BladderCancer https://t.co/0Pctq11WLJ
๐ 0 โค๏ธ 1 ๐ 0 ๐ 27
6 trials (2 phase III, 3 phase II, 1 phase I) opened this week, testing T-bren, saruparib, transdermal estrogen, SX-682, GI-102 plus pasritamig and UGN-501
Phase 3 ยท SystImmune Inc. ยท T-bren ยท Georgia ยท CT.gov โ
Phase 3 ยท AstraZeneca ยท saruparib ยท Arkansas, California, Florida, Hawaii, Illinois, Iowa +14 more ยท CT.gov โ
Phase 2 ยท Fred Hutchinson Cancer Center ยท transdermal estrogen ยท Washington ยท CT.gov โ
Phase 1/2 ยท National Cancer Institute (NCI) ยท SX-682 ยท Maryland ยท CT.gov โ
Phase 1/2 ยท GI Innovation, Inc. ยท GI-102 plus pasritamig ยท New York ยท CT.gov โ
Phase 1 ยท UroGen Pharma, Inc., a subsidiary of UroGen Pharma Ltd. ยท UGN-501 ยท Arizona, California, Colorado, Florida, Massachusetts, Michigan +6 more ยท CT.gov โ
Open all 6 on the trials page โ
Agent descriptions from the NCI Thesaurus.
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