Addressing Unmet Needs in MIBC

In this episode, “Addressing Unmet Needs in MIBC,” the panelists explore ongoing challenges and unanswered questions in the management of muscle-invasive bladder cancer (MIBC) despite major advances in perioperative therapy. The expert urologic oncology faculty discuss how the impressive pathologic complete response rates observed with newer regimens, including enfortumab vedotin plus pembrolizumab (EVP), are prompting important conversations about the future role of radical cystectomy and the potential for bladder preservation strategies.

Throughout the discussion, the panel examines whether some patients achieving complete clinical responses after systemic therapy may eventually avoid surgery, while emphasizing the importance of approaching bladder preservation cautiously and within clinical trial protocols. The faculty highlight concerns surrounding under staging, occult residual disease, and the current limitations of imaging, transurethral resection, and circulating tumor DNA (ctDNA) in accurately identifying complete responders.

The panelists also review emerging data evaluating discrepancies between apparent clinical responses and final surgical pathology findings, reinforcing the continued importance of radical cystectomy in current practice. In addition, the discussion explores the need for improved biomarkers and more precise methods of patient selection before bladder-sparing approaches can be safely adopted more broadly. Finally, the faculty discuss ongoing unmet needs for patients with variant histology’s and neuroendocrine bladder cancer subtypes. The panel emphasizes the importance of continued clinical trial development and collaborative research efforts to improve outcomes for these higher-risk patient populations with MIBC.

The next episode in this series, “Emerging Combination Perioperative Strategies in MIBC,” features the panelists discussing emerging clinical trials evaluating combination perioperative therapies in muscle-invasive bladder cancer. The panel also highlights how treatment sequencing and adjuvant therapy intensity may shape future perioperative management strategies in MIBC.