Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology
The management of muscle-invasive bladder cancer (MIBC) has significantly advanced, especially in addressing the challenges faced by older patients with comorbidities.
While radical cystectomy with perioperative systemic therapy and chemoradiation remain standard treatments, immune checkpoint blockade (ICB) has now been incorporated into neoadjuvant and adjuvant settings.
Emerging approaches include:
- Using circulating tumor DNA to guide adjuvant ICB, currently under clinical evaluation.
- Combining antibody-drug conjugates with ICB in the perioperative setting, showing promise to improve outcomes.
Improved systemic therapies with higher pathologic complete response rates are enabling more personalized, risk-adapted bladder-sparing approaches.
The field is poised for major shifts through the integration of novel therapeutics, biomarkers, and individualized strategies.