Neoadjuvant therapy for muscle-invasive bladder cancer

Area of Science:

• Uro-oncology
• Medical oncology
• Cancer research

Background:

• Muscle-invasive bladder cancer (MIBC) is an aggressive malignancy with high recurrence rates.
• Cisplatin-based neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) improves survival for MIBC.
• Immune checkpoint inhibitors (ICIs) have transformed metastatic urothelial carcinoma treatment and are being explored in the neoadjuvant setting.

Purpose of the Study:

• To review current guidelines for MIBC management.
• To summarize NAC regimens for MIBC.
• To discuss the role and future of ICIs in neoadjuvant therapy for MIBC.

Main Methods:

• Review of existing guidelines for MIBC management.
• Summary of published literature on NAC regimens.
• Analysis of studies evaluating ICIs in the neoadjuvant setting for MIBC.

Main Results:

• Cisplatin-based NAC is the established standard for MIBC prior to RC.
• Pembrolizumab and atezolizumab monotherapy demonstrate feasibility and notable pathologic response rates.
• Ongoing trials investigate combinations of cisplatin-based chemotherapy with ICIs and ICI-alone approaches.

Conclusions:

• Cisplatin-based NAC remains the standard for operable MIBC.
• ICIs represent a promising therapeutic avenue in the neoadjuvant setting for MIBC.
• Molecular subclassification and biomarkers are crucial for optimizing future MIBC treatment strategies.