Journal: Current treatment options in oncology
This publication reviews the rapidly evolving management of muscle-invasive bladder cancer (MIBC), highlighting the critical role of neoadjuvant and adjuvant therapies alongside biomarker-driven patient selection.
While cisplatin-based neoadjuvant chemotherapy remains the standard, its limited use due to toxicity and eligibility issues has prompted investigation into immune checkpoint inhibitors and targeted therapies. These include FGFR inhibitors and antibody-drug conjugates (ADCs) targeting Nectin-4 and HER2.
- FGFR3 alterations predict response to FGFR inhibitors.
- HER2 overexpression may guide ADC use.
Circulating tumor DNA (ctDNA) is emerging as a valuable prognostic and predictive biomarker, aiding dynamic treatment modulation in perioperative trials.
Recent phase 3 trials, including CheckMate 274, Alliance AMBASSADOR, and NIAGARA, demonstrated improved disease-free and overall survival with immune checkpoint blockade added to standard chemotherapy.
Future advances depend on integrating multi-omics, liquid biopsies, and adaptive clinical trials, but challenges remain in biomarker standardization, validation, and clinical application.
Large prospective studies and collaboration are essential to advance precision medicine in MIBC.