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Background <p>Muscle-invasive bladder cancer (MIBC) is an aggressive malignancy that, despite radical cystectomy, is frequently associated with disease recurrence and limited prognosis. To improve oncologic outcomes, neoadjuvant and adjuvant systemic therapies have become standard components of treatment. Emerging perioperative strategies—particularly immunochemotherapy combinations and the use of antibody–drug conjugates (ADCs)—are currently under investigation in large phase&#xa0;III clinical trials, with results expected soon.</p> Objective <p>This review provides a&#xa0;current overview of clinical trial data and therapeutic recommendations for the perioperative management of MIBC.</p> Materials and methods <p>A&#xa0;targeted literature review was conducted, including international and national guidelines as well as relevant phase&#xa0;II and&#xa0;III studies on perioperative systemic treatment approaches for MIBC.</p> Results and conclusion <p>Cisplatin-based neoadjuvant chemotherapy remains the standard of care in the perioperative treatment of MIBC. Recent studies have demonstrated that the addition of perioperative durvalumab (a&#xa0;PD-L1 checkpoint inhibitor) confers a&#xa0;survival benefit. For cisplatin-ineligible and PD-L1-positive patients, adjuvant immunotherapy with nivolumab is currently the only approved option. Ongoing trials evaluating perioperative immuno-, chemo-, and ADC-based combinations are expected to address current gaps in evidence. Enhanced response rates with novel systemic regimens have also renewed interest in bladder-sparing approaches. Precision tools such as circulating tumor DNA (ctDNA) may help to optimize patient selection and avoid both over- and undertreatment in the future.</p>

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Aktuelle Fortschritte der perioperativen Systemtherapie des muskelinvasiven Blasenkarzinoms

  • 期刊论文

  • 发表日期：

    2025年12月4日

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  • C. Aydogdu,
  • J. Casuscelli

摘要

Background

Muscle-invasive bladder cancer (MIBC) is an aggressive malignancy that, despite radical cystectomy, is frequently associated with disease recurrence and limited prognosis. To improve oncologic outcomes, neoadjuvant and adjuvant systemic therapies have become standard components of treatment. Emerging perioperative strategies—particularly immunochemotherapy combinations and the use of antibody–drug conjugates (ADCs)—are currently under investigation in large phase III clinical trials, with results expected soon.

Objective

This review provides a current overview of clinical trial data and therapeutic recommendations for the perioperative management of MIBC.

Materials and methods

A targeted literature review was conducted, including international and national guidelines as well as relevant phase II and III studies on perioperative systemic treatment approaches for MIBC.

Results and conclusion

Cisplatin-based neoadjuvant chemotherapy remains the standard of care in the perioperative treatment of MIBC. Recent studies have demonstrated that the addition of perioperative durvalumab (a PD-L1 checkpoint inhibitor) confers a survival benefit. For cisplatin-ineligible and PD-L1-positive patients, adjuvant immunotherapy with nivolumab is currently the only approved option. Ongoing trials evaluating perioperative immuno-, chemo-, and ADC-based combinations are expected to address current gaps in evidence. Enhanced response rates with novel systemic regimens have also renewed interest in bladder-sparing approaches. Precision tools such as circulating tumor DNA (ctDNA) may help to optimize patient selection and avoid both over- and undertreatment in the future.