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Peer-reviewedCC BY-NC 4.0Cancer Management and Research

Neoadjuvant Nivolumab–Ipilimumab versus Platinum-Based Chemotherapy in Muscle-Invasive Bladder Cancer: A Single-Institution, Propensity-Weighted Cohort Study

  • Li-Hua Huang1,2,3
  • Min-Che Tung1
  • Wei-Chun Weng1,4,5
  • Chao-Yu Hsu1,5
  • Yen-Chuan Ou1,2,3
  • Chi-Chien Lin2,3,6,7
7 affiliations
  1. 1Department of Urology, Tungs’ Taichung MetroHarbor Hospital, Taichung, Taiwan
  2. 2Doctoral Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan
  3. 3Rong Hsing Translational Medicine Research Center, National Chung Hsing University, Taichung, Taiwan
  4. 4Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
  5. 5Department of Nursing, Jenteh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
  6. 6Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
  7. 7Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan
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Abstract

Introduction: Neoadjuvant chemotherapy (NAC) is standard for muscle-invasive bladder cancer (MIBC), yet many patients are platinum-ineligible. We compared outcomes of neoadjuvant nivolumab plus ipilimumab versus platinum-based NAC.

Methods: This single-institution comparative cohort study compared a prospective immune checkpoint inhibitor (ICI) cohort (n=11) receiving nivolumab (1 mg/kg) plus ipilimumab (3 mg/kg) against a retrospective platinum-based NAC cohort (n=30). Propensity score-based overlap weighting was used to reduce measured confounding. Main outcomes included pathologic complete response (pCR), downstaging (<ypT2N0), and overall survival (OS).

Results: Among surgically evaluable patients (ICI n=9; NAC n=30), pCR rates were 22.2% and 26.7%, respectively (p=1.00), and downstaging rates were 44.4% and 50.0% (p=1.00). Propensity-weighted analyses likewise showed no statistically significant differences in pathologic response. In the total ICI cohort (n=11), four patients (36.4%) did not complete all four planned cycles, including three because of grade 3 immune-related toxicity and one who died following an on-treatment acute myocardial infarction. At a median follow-up of 58.3 months in the ICI cohort, no recurrences were observed among the nine surgically treated patients during the available follow-up, compared with nine recurrences (30.0%) in the NAC cohort. Two-year OS was 100% in the ICI group and approximately 80% in the NAC group (log-rank p=0.18).

Conclusion: Neoadjuvant dual ICI demonstrated pathologic activity, with response rates numerically within the range observed with standard NAC. Clinically meaningful immune-related adverse events were observed in the ICI cohort; however, no recurrences were observed among surgically treated ICI patients during the available follow-up. These findings support further investigation of dual ICI as a potential option when platinum-based NAC is not feasible or is declined.

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Cite

BibTeXRIS
BibTeX
@article{huang2026neoadjuvant,
  title = {{Neoadjuvant Nivolumab–Ipilimumab versus Platinum-Based Chemotherapy in Muscle-Invasive Bladder Cancer: A Single-Institution, Propensity-Weighted Cohort Study}},
  author = {Li-Hua Huang and Min-Che Tung and Wei-Chun Weng and Chao-Yu Hsu and Yen-Chuan Ou and Chi-Chien Lin},
  journal = {Cancer Management and Research},
  year = {2026},
  month = nov,
  doi = {10.2147/cmar.s642002},
  url = {https://doi.org/10.2147/cmar.s642002},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Neoadjuvant Nivolumab–Ipilimumab versus Platinum-Based Chemotherapy in Muscle-Invasive Bladder Cancer: A Single-Institution, Propensity-Weighted Cohort Study
AU  - Li-Hua Huang
AU  - Min-Che Tung
AU  - Wei-Chun Weng
AU  - Chao-Yu Hsu
AU  - Yen-Chuan Ou
AU  - Chi-Chien Lin
PY  - 2026
DA  - 2026/11/01
JO  - Cancer Management and Research
DO  - 10.2147/cmar.s642002
UR  - https://doi.org/10.2147/cmar.s642002
AB  - Introduction: Neoadjuvant chemotherapy (NAC) is standard for muscle-invasive bladder cancer (MIBC), yet many patients are platinum-ineligible. We compared outcomes of neoadjuvant nivolumab plus ipilimumab versus platinum-based NAC.  Methods: This single-institution comparative cohort study compared a prospective immune checkpoint inhibitor (ICI) cohort (n=11) receiving nivolumab (1 mg/kg) plus ipilimumab (3 mg/kg) against a retrospective platinum-based NAC cohort (n=30). Propensity score-based overlap weighting was used to reduce measured confounding. Main outcomes included pathologic complete response (pCR), downstaging (<ypT2N0), and overall survival (OS).  Results: Among surgically evaluable patients (ICI n=9; NAC n=30), pCR rates were 22.2% and 26.7%, respectively (p=1.00), and downstaging rates were 44.4% and 50.0% (p=1.00). Propensity-weighted analyses likewise showed no statistically significant differences in pathologic response. In the total ICI cohort (n=11), four patients (36.4%) did not complete all four planned cycles, including three because of grade 3 immune-related toxicity and one who died following an on-treatment acute myocardial infarction. At a median follow-up of 58.3 months in the ICI cohort, no recurrences were observed among the nine surgically treated patients during the available follow-up, compared with nine recurrences (30.0%) in the NAC cohort. Two-year OS was 100% in the ICI group and approximately 80% in the NAC group (log-rank p=0.18).  Conclusion: Neoadjuvant dual ICI demonstrated pathologic activity, with response rates numerically within the range observed with standard NAC. Clinically meaningful immune-related adverse events were observed in the ICI cohort; however, no recurrences were observed among surgically treated ICI patients during the available follow-up. These findings support further investigation of dual ICI as a potential option when platinum-based NAC is not feasible or is declined.
SN  - 1179-1322
ER  -