Dr Efstathiou on the Evolution of Trimodal Therapy in MIBC

Jason Efstathiou, MD, DPhil, radiation oncologist, professor, radiation oncology, Harvard Medical School; vice-chair, Faculty & Academic Affairs, director, Genitourinary Service, Department of Radiation Oncology; clinical co-director, The Claire and John Bertucci Center for Genitourinary Cancers, Massachusetts General Hospital, discusses the ongoing evaluation of the utility of trimodaltherapy in patients with muscle-invasive bladder cancer (MIBC).

Efstathiou discussed the status of trimodality therapy in the management of patients diagnosed with MIBC in a presentation given during The Radiation Oncology Summit: ACRO 2024. Efstathiou delved into current bladder-preservation strategies for MIBC. He begins by stating that a significant portion of patients diagnosed with MIBC across the United States are not receiving definitive therapy. Instead, they undergo repeated Transurethral Resection of Bladder Tumor (TURBT) and sometimes some intravesical therapy, which falls short of adequate management for muscle-invasive disease, he adds. This underscores the existence of an overlooked and inadequately served demographic grappling with this severe ailment, Efstathiou elucidates.

Trimodality therapy, a protocol combining cystoscopic resection of the bladder tumor with chemoradiation, emerges as a key strategy aimed at bladder conservation, he expands. Accumulated data now substantiate the feasibility of trimodal therapy as a viable treatment alternative for numerous patients with MIBC, Efstathiou reports. Encouragingly, this therapeutic approach is endorsed by national guidelines, boasting a category I recommendation per the National Comprehensive Cancer Network guidelines, and has received support from various other authoritative sources, he explains.

Patients undergoing trimodality therapy for bladder preservation have a favorable prognosis, over 85% of patients successfully retain their bladders, and long-term quality of life remains satisfactory, Efstathiou continues. Comparative analyses of trimodal therapy vs radical cystectomy in clinically matched patient cohorts indicate comparable outcomes between the 2 treatments, offering reassurance regarding the efficacy of trimodal therapy, he states. Trimodality therapy presents a viable substitute for surgery and holds promise for yielding outcomes on par with the gold standard treatment, Efstathiou concludes.