Perioperative Therapy Expansion in Cisplatin-Ineligible MIBC

In “Perioperative Therapy Expansion in Cisplatin-Ineligible MIBC,” our panel explores how the treatment paradigm for muscle-invasive bladder cancer (MIBC) is rapidly evolving with the emergence of effective perioperative therapies for cisplatin-ineligible patients. The expert faculty discuss how traditional approaches that relied heavily on determining cisplatin eligibility are changing in light of recent clinical trial data supporting enfortumab vedotin plus pembrolizumab (EVP) in patients who historically would have proceeded directly to surgery.

Throughout the discussion, the panelists review how the EV-303/KEYNOTE-905 findings are influencing treatment selection and expanding the population of patients considered candidates for systemic therapy prior to radical cystectomy. The faculty highlight the significant improvements in event-free survival observed with EVP and discuss how these outcomes are reshaping expectations for patients previously viewed as poor candidates for neoadjuvant treatment.

The panel also examines which patients may still require upfront surgery, including those with severe hematuria, debilitating lower urinary tract symptoms, significant autoimmune disease, or other clinical considerations limiting systemic therapy use. In addition, the discussion explores the complex relationship between cancer-related outcomes, comorbidities, frailty, and overall survival in cisplatin-ineligible populations. Finally, the faculty discuss how perioperative systemic therapy may not only improve oncologic outcomes, but also potentially reduce tumor burden rapidly enough to provide symptomatic relief and improve quality of life for selected patients with MIBC.

Our next episode, “Comparing Perioperative Strategies in Cisplatin-Eligible MIBC,” features the panelists discussing how perioperative EVP compares with traditional cisplatin-based chemotherapy in patients with muscle-invasive bladder cancer. The panel also highlights how emerging clinical data are influencing treatment selection and shaping the future of perioperative management in MIBC.