Onkologie. 2025:19(2):80-82 | DOI: 10.36290/xon.2025.017

Neoadjuvant therapy of bladder cancers

Tomáš Büchler

Onkologická klinika 2. LF UK a Fakultní nemocnice v Motole, Praha

Muscle-invasive bladder cancer (MIBC) is an aggressive malignancy with a high risk of metastases and recurrence. The standard treatment involves neoadjuvant cisplatin-based chemotherapy followed by radical cystectomy, yet approximately 50 % of patients relapse within three years. Neoadjuvant chemotherapy improves overall survival (OS) and pathological complete response (pCR). Emerging treatment strategies include neoadjuvant immunotherapy, with phase II trials demonstrating increased pCR rates with pembrolizumab and atezolizumab. The recently published NIAGARA trial established that perioperative durvalumab combined with chemotherapy reduces disease progression risk by 32 % (HR = 0.68) and mortality risk by 25 % (HR = 0.75). This supports perioperative immunotherapy as the new standard of care. Ongoing studies focus on combining ADCs and ICIs and leveraging ctDNA to refine patient selection. These advancements drive personalized oncology and optimize neoadjuvant therapy.

Keywords: neoadjuvant therapy, bladder cancer, immunotherapy, circulating tumor DNA, perioperative treatment.

Accepted: April 25, 2025; Published: May 2, 2025  Show citation