Bladder cancer

Adjuvant treatment approaches for MIBC

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Educational Objective: Understand the management of muscle-invasive bladder cancer (MIBC) after radical cystectomy (RC) or trimodality bladder-preservation therapy (TMT).
Specialty: Urology, medical oncology, clinical oncology, radiation oncology
Target Audience: CME (basic, intermediate), Residents (senior)
Latest update: May 2024

Management of MIBC after surgery depends on the risk for disease recurrence. Adjuvant cisplatin-based combination chemotherapy has been used since the 1980s, but it can only be used in certain patients and the response rate is limited. Adjuvant nivolumab is another option for patients with a high risk of recurrence, while other immunotherapies are still under investigation in predefined patient populations. Finally, phase II and III data demonstrated benefits of adjuvant radiotherapy (RT) in terms of locoregional control and disease-free survival in patients at high risk for locoregional relapse.

All patients in this course have urothelial carcinoma (UCa) in absence of (extensive) histological subtypes.

Regulatory approval status of adjuvant drugs for MIBC (status 3 May 2024)

*The definition of high risk of recurrence is based on the Checkmate 274 trial and includes: 1) pT2-4a or pN+ in patients who received neoadjuvant chemotherapy (NAC) or 2) pT3-4a or pN+ in patients who did not receive NAC and are ineligible for or refuse adjuvant cisplatin-based chemotherapy