Muscle-invasive bladder cancer

A presentation at Gathering Around Cancer 2025 focused on perioperative therapies for muscle-invasive bladder cancer (MIBC).

In the talk, Dr Min Yuen Teo, Beaumont Hospital, Dublin, looked at epidemiology in the Irish context, and provided an overview of MIBC, from how it was treated in the past to current practice. He also gave a brief overview of recent advancements in the clinical setting.

Dr Teo delivered a brief synopsis of the clinical significance of MIBC and presented data from the National Cancer Registry Ireland. Men are more at risk of bladder cancer than women, at approximately a four-to-one ratio, and the incidence increases with age – around 70 per cent of Irish patients are diagnosed when they are over the age of 65.

Much of Dr Teo’s work has focused on how to make cisplatin-based chemotherapy more effective, and he presented data from the IMvigor010 study, as well as the KEYNOTE-905/EV-303 trial, which looked at perioperative pembrolizumab (pembro) or pembro plus enfortumab vedotin for MIBC.

The five-year survival rate for MIBC has grown slightly but steadily, he pointed out, from approximately 70 per cent in 1994–1998, to 75 per cent from 2019–2022. “Neoadjuvant cisplatin-based chemotherapy -> RC [radical cystectomy] is superior to RC alone in eligible patients,” Dr Teo said. “However, around 50 per cent of patients remain cisplatin-ineligible. [We can consider] adjuvant nivolumab, and perhaps pembrolizumab, for high-risk patients after RC, but the recurrence rate is still high – approximately 30 per cent in the best curve to date. We can use ctDNA to select the high-risk patients who are more likely to benefit and shift the curve.” Chemoimmunotherapy can also be considered as a therapeutic option, he added.