Suzanne B. Merrill, MD, on the evolving perioperative landscape in MIBC

In this video, Suzanne B. Merrill, MD, FACS, of Colorado Urology, discusses how emerging perioperative treatment approaches are reshaping the management of muscle-invasive bladder cancer (MIBC), including the potential impact of new clinical trial data on treatment selection and personalization. Recorded at the 2026 LUGPA Annual Meeting, Merrill highlights the evolving role of enfortumab vedotin-ejfv (EV; Padcev) plus pembrolizumab (P; Keytruda) and the potential implications of the VOLGA trial (NCT04960709) findings.

Merrill explains that the growing use of perioperative EV plus P has challenged traditional definitions of cisplatin eligibility, shifting the conversation toward broader treatment considerations for patients with MIBC. However, results from the VOLGA trial, which evaluated perioperative EV plus durvalumab (Imfinzi) followed by adjuvant durvalumab, could introduce another treatment option and prompt further discussion about the appropriate level of treatment intensity for individual patients.

Looking ahead, Merrill anticipates that treatment selection may become increasingly personalized based on disease characteristics and biomarkers, including clinical stage and circulating tumor DNA (ctDNA) status. For example, patients with more advanced disease or positive ctDNA may benefit from a more intensive perioperative approach, whereas those with more localized disease could be candidates for an alternative regimen. She also emphasizes the importance of collaboration between urologists and medical oncologists in navigating these decisions, particularly as treatment administration and expertise continue to be shared across specialties.

“It'll be an interesting time, and I think a very important discussion to have with your medical oncologist,” she explains. A lot of us urologists are not administering EV right now, so we are sharing that space still, and rightfully so, with our medical oncologists as to what perioperative regimen we're going to put these patients on.”