The Evolving Treatment Landscape in MIBC

Welcome back to another Urology Times Peer Exchange series. In this episode titled, “The Evolving Treatment Landscape in MIBC,” the expert faculty discuss how the treatment landscape for muscle-invasive bladder cancer (MIBC) is evolving with the emergence of perioperative treatment strategies that integrate systemic therapy before and after surgery. The panel reviews how management has shifted from the traditional paradigm of cisplatin-based neoadjuvant chemotherapy alone toward coordinated perioperative approaches incorporating immunotherapy and antibody-drug conjugates alongside radical cystectomy.

Throughout the discussion, the panelists examine how recently approved regimens, including perioperative durvalumab plus gemcitabine-cisplatin and enfortumab vedotin plus pembrolizumab, are influencing clinical practice and reshaping treatment sequencing for cisplatin-eligible and ineligible patients. The faculty also discuss the growing role of pathologic complete response and evolving surgical considerations in the modern era of MIBC management.

In addition, the panel highlights the practical implications of integrating perioperative therapy into multidisciplinary care, including how urologists are adapting to new systemic therapies, treatment-related adverse events, and changing expectations around outcomes. The discussion provides important context for understanding how perioperative strategies are redefining both the medical and surgical management of MIBC.

In the next episode, “The Emerging Perioperative Era in MIBC with the NIAGARA Trial,” panelists will continue their discussion on muscle-invasive bladder cancer and highlight how perioperative approaches are influencing treatment selection, surgical planning, and recovery following radical cystectomy. The panel will also discuss practical strategies for integrating these therapies into multidisciplinary clinical practice.