(UroToday.com) The European Society of Medical Oncology (ESMO) 2021 annual meeting’s non-prostate cancer mini-oral session included a presentation by Dr. Nieves Martinez Chanza discussing results of avelumab as neoadjuvant therapy in platinum eligible and ineligible patients with muscle-invasive bladder cancer (MIBC). Cisplatin-based neoadjuvant chemotherapy followed by radical cystectomy is considered as standard of care for non-metastatic muscle-invasive bladder cancer patients based on a modest survival benefit correlated with pathological complete response. However, up to 50% of patients are ineligible for cisplatin-based chemotherapy. Avelumab is a monoclonal antibody directed against PD-L1, indicated in locally advanced or metastatic urothelial cancer. Neoadjuvant studies demonstrate promising antitumor activity of immune checkpoint inhibitors, with single-agent <ypT2N0 rates of 39-56% and in combination with chemotherapy <ypT2N0 rates of 56-69%. Dr. Martinez Chanza and colleagues hypothesized that neoadjuvant avelumab would increase the rates of pathologic response and improve clinical outcomes when combined with standard chemotherapy. At the ESMO 2021 congress, they reported preliminary data from the AURA trial assessing preoperative avelumab with two cisplatin-based regimens in the cisplatin eligible cohort.