Advancing Perioperative Treatment Options for Localized Muscle-Invasive Bladder Cancer: A Step Forward

Area of Science:

• Uro-oncology
• Medical oncology
• Immunotherapy

Background:

• Muscle-invasive bladder cancer (MIBC) has a high recurrence rate post-surgery.
• Current standard neoadjuvant chemotherapy offers survival benefits but is not effective for all patients.
• Cisplatin eligibility remains a challenge for a significant portion of MIBC patients.

Purpose of the Study:

• To review the rationale and evidence for perioperative immunotherapy in MIBC.
• To discuss emerging treatment strategies including neoadjuvant chemotherapy with adjuvant immunotherapy and universal perioperative immunotherapy.
• To outline the challenges and future directions in the perioperative management of MIBC.

Main Methods:

• Literature review of clinical trials and studies on perioperative immunotherapy for MIBC.
• Analysis of treatment outcomes, including overall survival and recurrence rates.
• Evaluation of different immunotherapy approaches within the perioperative setting.

Main Results:

• Neoadjuvant chemotherapy improves overall survival in cisplatin-eligible MIBC patients.
• Despite treatment, 40-50% of patients experience recurrence.
• Perioperative immunotherapy strategies are being explored to overcome treatment resistance and improve outcomes.

Conclusions:

• Perioperative immunotherapy represents a promising approach for MIBC management.
• Risk-adapted adjuvant immunotherapy and universal perioperative immunotherapy are key emerging strategies.
• Further research is needed to optimize immunotherapy integration and address challenges in MIBC treatment.