Nima Almassi, MD, highlights long-term data on bladder preservation in MIBC

In this video, Nima Almassi, MD, discusses the current evidence for bladder preservation using neoadjuvant systemic therapy followed by active surveillance in select patients with muscle-invasive bladder cancer (MIBC). Almassi is a urologic oncologist at Cleveland Clinic in Cleveland, Ohio.

Almassi emphasizes that this strategy should be distinguished from other bladder-preserving approaches, such as trimodal therapy and partial cystectomy. The approach discussed involves treating patients with MIBC with neoadjuvant systemic therapy and transurethral resection (TUR), followed by active surveillance without additional local therapy. Current evidence suggests that patients who achieve a complete clinical response may be the best candidates, with the goal of preserving quality of life without compromising oncologic outcomes.

He highlights long-term data from a Memorial Sloan Kettering Cancer Center study involving 101 patients who met established criteria for bladder preservation and achieved a clinical complete response following cisplatin-based chemotherapy and TUR.¹ These patients had features including a solitary tumor of 5 cm or smaller and clinical stage T2 disease.

At 15 years, the risk of bladder cancer–specific mortality was 11% (95% CI, 5.8 to 18), and the risk of cystectomy was also 11% (95% CI, 5.9 to 18). Bladder preservation outcomes were approximately 40:40:10:10 for death from another cause, alive with an intact bladder, cystectomy, and death from bladder cancer. Among patients who remained alive with an intact bladder, approximately one-third experienced a local recurrence.

Almassi noted that while the results are promising, the risk of local recurrence also suggests that clinical characteristics currently used for patient selection are not sufficient to reliably identify those who can safely omit local therapy. Further tools to better determine which patients have durable disease eradication will therefore be important as bladder-preservation strategies continue to evolve.

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