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Bladder preservation after neoadjuvant therapy - 2021 IBCN updates part 1.

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Bladder preservation after neoadjuvant therapy (NAT) is feasible for muscle-invasive bladder cancer (MIBC). Accurate staging and identifying cisplatin-sensitive tumors, potentially via DNA damage response (DDR) gene alterations, are key for optimal patient selection.

Keywords:
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Area of Science:

  • Oncology
  • Urology

Background:

  • Radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) is associated with significant morbidity.
  • Bladder preservation strategies are being explored following neoadjuvant therapy (NAT).

Purpose of the Study:

  • To review the accuracy of staging modalities for MIBC after NAT.
  • To investigate clinical outcomes of bladder preservation in MIBC patients.
  • To discuss the role of DNA damage response (DDR) gene alterations in predicting treatment response.

Main Methods:

  • Review of contemporary staging modalities.
  • Analysis of clinical outcomes in MIBC patients undergoing bladder preservation post-NAT.
  • Evaluation of the predictive value of DDR gene alterations.

Main Results:

  • Contemporary staging modalities have limitations in accurately assessing MIBC post-NAT.
  • Bladder preservation after NAT shows promising clinical outcomes in selected MIBC patients.
  • Cisplatin-sensitizing DDR gene alterations are crucial for identifying suitable candidates.

Conclusions:

  • Accurate staging and identification of cisplatin sensitivity are critical for successful bladder preservation in MIBC.
  • DDR gene alterations hold predictive value and are foundational to ongoing clinical trials for bladder preservation.