LUGPA 2025 CME Enduring Program: Operationalizing the Science -Translating New Concepts into Clinical Practice-2025 CME Program Part 2

Video Transcription

Video Summary

Dr. Joshua Meeks from Northwestern University discusses advances in the management of muscle-invasive bladder cancer (MIBC). Traditional treatment involved cystectomy after neoadjuvant chemotherapy (e.g., MVAC). However, recent trials like NIAGARA and EV303 show improved outcomes with immunotherapy added to chemotherapy, such as durvalumab or enfortumab vedotin-pembrolizumab (EV Pembro), raising the possibility of bladder preservation. The use of ctDNA as a biomarker is emerging to guide perioperative decisions, better identifying patients for adjuvant immunotherapy and helping tailor treatment, potentially sparing some from toxicity. Dr. Meeks predicts cystectomy may become less common with effective systemic and local therapies. In non-muscle invasive disease, experts highlight the importance of rigorous BCG protocols and individualized decisions on adding checkpoint inhibitors, considering patient preference and tolerance. Novel intravesical agents are under trial to improve outcomes in intermediate-risk patients. Biomarker tests like the Vesta ctDNA assay, although not yet definitive for guiding all decisions, are useful adjuncts in risk stratification, especially for patients with persistent or recurrent disease. The dialogue emphasizes multidisciplinary approaches, shared decision-making, and evolving personalized care models aimed at improving efficacy, reducing morbidity, and preserving quality of life in bladder cancer management.

Keywords

muscle-invasive bladder cancer

MIBC

cystectomy

neoadjuvant chemotherapy

immunotherapy

ctDNA biomarker

bladder preservation

checkpoint inhibitors