Why team-based care is now essential for muscle-invasive bladder cancer

In this video, Joshua J. Meeks, MD, PhD, the Edward M. Schaeffer, MD, PhD Professor of Urology and associate professor of urology, biochemistry, and molecular genetics at Northwestern University Feinberg School of Medicine in Chicago, Illinois, emphasizes the increasingly central role urologists play in the diagnosis, risk stratification, and longitudinal management of patients with muscle-invasive bladder cancer (MIBC).

Meeks describes the modern treatment course as a “spectrum of care” that begins with urologists, who not only make the initial diagnosis but also guide patients through the complex sequence of neoadjuvant therapy, surgery or bladder-sparing approaches, and subsequent adjuvant treatments. Historically, many patients resisted discussions about cystectomy, often halting consideration of multidisciplinary care. Today, however, urologists are responsible for initiating conversations earlier and framing systemic therapy as a first step, revisiting surgical decision-making once patients have progressed through initial treatment phases.

Meeks highlights that collaboration between urologists and medical oncologists has become essential, particularly with the emergence of combinations such as enfortumab vedotin-ejfv (EV, Padcev) plus pembrolizumab (Keytruda). He explains that previous distinctions between platinum-eligible and platinum-ineligible patients no longer dictate referral patterns. Instead, nearly all patients with MIBC should have early evaluation by medical oncology, whether for neoadjuvant candidacy or because they will likely require adjuvant therapy later. As a result, care for MIBC in 2025 is inherently team-based, typically involving urology, medical oncology, and radiation oncology.

Discussing ongoing clinical trials, Meeks comments on KEYNOTE-B15/EV-304 in the context of KEYNOTE-905/EV-303. He notes that in KEYNOTE-905/EV-303, many patients labeled “platinum-refusing” actually had adequate renal function for cisplatin, enabling broader enrollment. These patients demonstrated strong responses, and although EV-304 will compare EV-pembrolizumab directly with chemotherapy—leading to expected differences in HRs—the pathologic response data remain compelling. With a 57% response rate in the intent-to-treat population, higher than seen with prior therapies, Meeks said he anticipates that the upcoming trial will yield positive results.