The decision to test Enfortumab Vedotin/Pembrolizumab (EVP) in early-stage muscle-invasive bladder cancer was directly driven by its "flabbergasting" results in the metastatic setting. This highlights a strategy where overwhelming late-stage efficacy signals a therapy should be rapidly moved to earlier, curative-intent settings.
The KIDO 905 trial revealed high rates of adverse events even in the control arm receiving only surgery. This suggests the invasive procedure itself is a major source of patient harm, paving the way for future surgery-free regimens if systemic treatments like EVP prove sufficiently effective.
The trial's 57.1% pathologic complete response (pCR) rate is deceptively conservative. It categorized patients who responded well but declined surgery as non-responders, suggesting the treatment's true biological efficacy is even higher than the already impressive reported figure.