A new recommendation from the National Institute for Health and Care Excellence (NICE) states that durvalumab can be used, within its marketing authorisation, as an option with gemcitabine and cisplatin for neoadjuvant treatment, and then alone for adjuvant treatment, of resectable muscle-invasive bladder cancer in adults.  
 
The usual treatment for muscle-invasive bladder cancer before surgery is gemcitabine plus cisplatin, and after surgery is best supportive care. If the cancer is at high risk of recurrence and the tumours express PD-L1 at 1% or more, adjuvant nivolumab may be used. 
  
Evidence from clinical trials shows that risk of recurrence is lower with neoadjuvant durvalumab with gemcitabine plus cisplatin, then adjuvant durvalumab, than with neoadjuvant gemcitabine plus cisplatin alone. Adjuvant durvalumab has not been directly compared with adjuvant nivolumab in a clinical trial. 
  
The economic model has uncertainties, but the cost-effectiveness estimate is within the range accepted by NICE. So, durvalumab can be used in these patients, as long as it is supplied under the commercial arrangement agreed with AstraZeneca. 

Muscle-invasive bladder cancer. Supplied by Jonathan Bailey, National Human Genome Research Institute, reproduced under a CC BY 2.0 license. https://flickr.com/photos/142595545@N03/27785800576