Comparing Perioperative Strategies in Cisplatin-Eligible MIBC

This episode, titled “Comparing Perioperative Strategies in Cisplatin-Eligible MIBC,” features panelists discussing how the KEYNOTE-B15/EV-304 trial is reshaping perioperative treatment considerations for patients with muscle-invasive bladder cancer (MIBC). The expert faculty review the study design evaluating perioperative enfortumab vedotin plus pembrolizumab (EVP) compared with standard neoadjuvant gemcitabine-cisplatin (Gem-CIS), and discuss how these findings may influence treatment selection in cisplatin-eligible patients.

Throughout the discussion, the panel highlights the significance of comparing newer antibody-drug conjugate and immunotherapy-based regimens directly against traditional cisplatin-based chemotherapy, rather than against surgery alone. The faculty examine the improvements observed with EVP across pathologic complete response, event-free survival, and overall survival outcomes, and discuss why these findings represent an important advancement in the perioperative treatment landscape.

The panelists also explore the practical challenges of interpreting cross-trial comparisons between NIAGARA and EV-304, including differences in patient populations and treatment approaches. In addition, the faculty discuss the growing complexity of treatment decision-making as multiple perioperative regimens become available for cisplatin-eligible patients with MIBC. Finally, the discussion highlights the importance of the observed overall survival benefit with EVP despite the use of adjuvant nivolumab in the control arm, reinforcing the potential role of EVP as a meaningful perioperative treatment option in the evolving management of MIBC.

In the next episode, “Addressing Unmet Needs in MIBC,” panelists will discuss ongoing challenges in muscle-invasive bladder cancer management, including bladder preservation strategies, under staging concerns, and the role of biomarkers following perioperative therapy. The panel will also highlight the need for additional research in variant histology’s and higher-risk patient populations with MIBC.