Practice changing of IO perioperative therapy in Muscle Invasive Bladder Cancer

Radical cystectomy combined with neoadjuvant chemotherapy has long been the standard treatment for patients with Muscle Invasive Bladder Cancer (MIBC). Recently, advancements in immuno-oncology have transformed the treatment landscape, extending from advanced bladder cancer to include perioperative therapy for MIBC. The Phase 3 NIAGARA study demonstrated that the combination of the immune checkpoint inhibitor (ICI) Durvalumab with chemotherapy offers significantly superior efficacy, safety, and prevention of metastasis in the perioperative setting for cisplatin-eligible MIBC patients.

This presentation will delve into the rationale for the upfront use of the ICI and chemotherapy combination as perioperative therapy in MIBC. Drawing from robust clinical trials and real-world clinical practice, I will emphasize the unmet medical needs and the development of ICI therapies for MIBC. The NIAGARA study's findings on efficacy, safety, prevention of metastasis, and impact on pathologic complete response (pCR) will highlight how early intervention with these agents maximizes event-free survival and enhances patient outcomes.

As treatment strategies evolve, the combination of ICI and chemotherapy sets the foundation for more effective approaches for MIBC patients. My aim is to foster a deeper understanding of this dynamic landscape and encourage thoughtful application of these insights in clinical practice to improve patient outcomes.