Biomarker, Diagnosis, and Evolving Treatment Paradigm in MIBC

The panel discussed the evolution of the muscle-invasive bladder cancer (MIBC) treatment paradigm from adjuvant-only strategies toward comprehensive perioperative approaches. They highlighted the growing impact of EV Pembro (EV-303) and other neoadjuvant combinations achieving high pathologic complete response rates, while emphasizing the need for ctDNA-guided treatment tailoring to reduce unnecessary adjuvant therapy and toxicity. They also noted ongoing studies such as VOLGA, exploring immunotherapy combinations without postoperative treatment. The panel underscored the future importance of biomarker-driven decision-making, including ctDNA monitoring for patients unable to receive immediate adjuvant therapy. The discussion concluded with a synthesis of key data—NIAGARA, EV-303, and IMvigor trials—affirming platinum eligibility, perioperative immunotherapy, and ctDNA-based risk assessment as cornerstones of modern MIBC management, while highlighting the potential of novel modalities like TAR-200 plus cetrelimab for future bladder-preserving strategies.