Dr. Enrique Grande, Head of the Medical Oncology Department at Ruber Internacional Hospital and Director of One Oncology Madrid, part of the Quirónsalud Group, has participated as second author and member of the Steering Committee of the international VOLGA study, a clinical trial that opens up new therapeutic possibilities for patients with muscle-invasive bladder cancer.

The results of this phase III clinical trial have recently been published in the prestigious scientific journal The New England Journal of Medicine and presented during a plenary session at the European Society for Medical Oncology (ESMO) Congress 2026, one of the world's leading international meetings dedicated to advances in cancer diagnosis and treatment.

Conducted across 229 centres in 25 countries and involving 695 patients, the VOLGA study has demonstrated that a new treatment strategy combining immunotherapy with a targeted therapy against cancer cells before surgery, followed by additional immunotherapy after surgery, significantly improves outcomes compared with surgery alone in certain patients with bladder cancer.

"It is an enormous source of pride and a true honour for me to have contributed, alongside researchers from so many countries and, above all, thanks to the generosity of patients and their families, to a study that could change the treatment of bladder cancer for the better," says Dr. Enrique Grande.

A New Strategy That Improves Survival

High resolution image. This link will open using lightbox, there may be a context switchDr. Enrique GrandeMuscle-invasive bladder cancer is a form of the disease in which the tumour has spread into the muscular layer of the bladder wall. In these cases, surgery to remove the bladder, known as radical cystectomy, is one of the main treatment options, although there remains a risk of the disease recurring afterwards.

Until now, one of the standard treatment approaches has involved administering cisplatin-based chemotherapy before surgery. However, not all patients are eligible for this treatment due to certain clinical conditions, such as impaired kidney function or other underlying health problems.

The VOLGA study specifically focused on patients who were unable to receive this type of chemotherapy or who had chosen not to undergo it.

"VOLGA offers us a new option for patients with bladder cancer that has invaded the muscular layer and who cannot receive cisplatin or have decided not to do so. The results show that we can improve disease control before surgery and increase survival by incorporating treatments both before and after the operation," explains the Head of the Medical Oncology Department at Ruber Internacional Hospital.

The research evaluated a combination of durvalumab, an immunotherapy drug that helps the immune system recognise and attack cancer cells, and enfortumab vedotin, a targeted therapy that delivers an anticancer agent directly to tumour cells.

The results show that, at two years, 63.5% of patients treated with this combination were alive and had experienced no disease progression, recurrence or other events defined in the study, compared with 45.1% of those who underwent surgery alone.

Furthermore, the estimated overall survival rate at two years reached 78.4% in the group receiving the new treatment strategy, compared with 69.4% in the surgery-only group.

These findings represent an important advance in the management of a disease for which effective therapeutic alternatives are essential, particularly for patients who cannot receive conventional chemotherapy treatments.

The trial also evaluated a second combination incorporating tremelimumab, another immunotherapy drug. This strategy significantly improved event-free survival compared with surgery alone, although it did not demonstrate a statistically significant improvement in overall survival in the analysis presented.

Improving Survival While Maintaining Quality of Life

One of the most significant aspects of the VOLGA study is the possibility of optimising both the duration and timing of treatment, seeking a balance between effectiveness and quality of life.

In this regard, Dr. Grande emphasises that the goal is not only to extend survival but also, whenever possible, to reduce the burden that treatments place on patients.

"But beyond living longer, we also care about how our patients live during that time. In VOLGA, enfortumab vedotin is administered for three cycles before surgery, without continuing it afterwards. This opens up the possibility of reducing exposure to this treatment and the burden it places on patients, with fewer visits to receive it and, above all, limiting the toxicities and complications associated with this drug, such as blood glucose abnormalities, skin reactions or loss of sensation and muscle strength," explains the specialist.

This strategy concentrates the administration of enfortumab vedotin before surgery, while immunotherapy with durvalumab continues after the operation. It therefore offers an alternative approach that improves clinical outcomes without requiring both drugs to be administered throughout the entire treatment process.

Nevertheless, the researchers emphasise the importance of assessing potential adverse effects and carefully selecting patients who may benefit from these combinations.

"I believe this study reminds us of something very important: in oncology, less can often be more. It is about finding the right treatment, for the right amount of time, while always placing each patient's needs at the centre," says Dr. Grande.

International Research and Personalised Oncology

Dr. Enrique Grande's participation as second author and member of the VOLGA study's Steering Committee highlights his role in the scientific development and leadership of international research aimed at improving cancer treatment options.

"Being part of the Steering Committee and contributing to the leadership of an international project of this magnitude also represents a great responsibility. I am deeply grateful for the trust of my colleagues and for the opportunity to contribute our experience from Spain to the development of new treatments for patients with bladder cancer around the world," says the oncologist.

Dr. Grande is also Director of One Oncology Madrid, Quirónsalud's comprehensive oncology care programme, focused on providing high-quality, personalised and multidisciplinary cancer care to patients across its network of private hospitals in the Community of Madrid.

The publication of the results in The New England Journal of Medicine and their presentation during a plenary session at ESMO underline the international significance of the VOLGA study and Dr. Grande's contribution to advancing new therapeutic strategies for patients with bladder cancer.