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The European Association of Urology (EAU) 2026 Annual Meeting
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| Bladder Preservation Post-Neoadjuvant Chemotherapy: A Smart Strategy or Risky Business?
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| Benjamin Pradere, MD, MSc, Fernando Maluf, MD, PhD, and Bogdana Schmidt, MD, MPH
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| This debate concluded that biomarker‑driven bladder preservation after neoadjuvant therapy in MIBC is promising but still experimental. Modern chemo‑immunotherapy plus tools like VI‑RADS MRI, ctDNA, and utDNA may identify strong clinical complete responders, yet current trials still show substantial local relapse and heavy reliance on intensive surveillance and timely salvage cystectomy, so routine omission of cystectomy outside studies remains risky.
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| MIBC Systemic Therapy: Maximise Early or Strategize Post-Op?
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| Matthew Galsky, MD, Thomas Powles, MBBS, MRCP, MD, and Patrizia Giannatempo, MD
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| This debate contrasted two evolving paradigms for systemic therapy in resectable MIBC. One side argued that peri-operative IO-based regimens for all cystectomy candidates—such as durvalumab plus cisplatin/gemcitabine (NIAGARA) and EV+pembrolizumab (KEYNOTE‑B15)—should become standard because they consistently increase pCR, improve event-free survival, and now show clear overall survival gains. The opposing view favored neoadjuvant chemotherapy followed by ctDNA-guided, risk-adapted adjuvant IO.
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| Debate Beyond the Muscle: Redefining MIBC Management: Pro: ctDNA Should Guide Adjuvant Decisions
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| Jørgen Jensen, MD
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| Jørgen Jensen argued that ctDNA should be central to adjuvant decision-making after cystectomy because it far outperforms traditional pathologic features at predicting recurrence. ctDNA-positive patients after surgery have very high relapse rates and clearly benefit from adjuvant immunotherapy in trials like IMvigor010/011 and TOMBOLA, whereas ctDNA-negative patients have excellent outcomes and can often safely avoid adjuvant treatment, reducing overtreatment and focusing IO or chemotherapy on those with true molecular residual disease.
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| State-of-the-Art Lecture Bladder-Sparing in MIBC: The Real-World Evidence
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| Jeremy Teoh, MBBS, FRCSEd (Urol), FCSHK, FHKAM (Surgery)
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| Teoh highlighted that bladder preservation in MIBC requires optimized multiparametric assessment and patient selection at every step—maximal TURBT, and systemic treatment with chemotherapy or emerging agents like ADCs plus checkpoint inhibitors—based on evidence that trimodality therapy matched radical cystectomy in disease-free and cancer-specific survival in Zlotta's large propensity-matched study and that ctDNA after trimodality therapy reliably predicts distant metastatic relapse.
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| State-of-the-Art Lecture Who Really Needs Surgery after Neo-Adjuvant
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| Alexandre R. Zlotta, MD, PhD, FRCSC
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| Alexandre Zlotta discussed that even with high pCR rates from modern peri‑operative regimens like durvalumab + cisplatin–gemcitabine and EV + pembrolizumab, we still cannot reliably pick which clinical complete responders can safely skip cystectomy or consolidation. Emerging ctDNA/utDNA‑ and MRI‑guided strategies are promising, but bladder preservation after neoadjuvant therapy should remain mainly within clinical trials or very highly selected patients.
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| Case-Based Panel Discussion Beyond Platinum: Evolving Frontlines in mUC: Where Do ADCs Fit in the Sequencing?
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| Matthew Galsky, MD, FASCO
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| Matt Galsky outlined that in the EV+pembrolizumab first‑line era for metastatic urothelial carcinoma, the key challenge with next‑generation ADCs is not drug scarcity but how best to sequence and combine them. Most combinations likely work via additivity or “independent drug action” rather than true synergy, so future strategy will hinge on payload class, resistance mechanisms, prior ADC exposure, disease tempo, and pragmatic issues like toxicity and cost when deciding between upfront combinations versus sequential use of ADCs targeting HER2, TROP2, nectin‑4, and others.
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| Urinary Markers versus Cystoscopy: Is It Time to Ditch the Scope?
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| Paolo Gontero, MD, Jeremy Teoh, MBBS, FRCSEd (Urol), FCSHK, FHKAM (Surgery), and Laura S. Mertens, MD, PhD
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| This debate concluded that urinary markers can help reduce cystoscopy frequency in carefully selected, low‑ and intermediate‑risk NMIBC patients, particularly older individuals, but cannot fully replace endoscopic surveillance yet. Randomized trials show marker‑guided follow‑up can safely cut cystoscopies, yet current assays still miss many low‑grade recurrences and generate false positives that trigger cascades of unnecessary tests, so most experts favor integrating markers alongside, not instead of, cystoscopy for now.
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| High-Risk BCG-naïve NMIBC: BCG + IO – Bold New Standard or Overreach?
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| Ashish M. Kamat, MD, MBBS, Neal D. Shore, MD, FACS, and Ekaterina Laukhtina, MD,
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| This debate concluded that adding systemic checkpoint inhibition to BCG in BCG‑naïve high‑risk NMIBC has level‑1 evidence for improving event‑free/disease‑free survival in adequately BCG‑treated, higher‑risk cohorts (CREST, POTOMAC; HR ~0.68), but also roughly quadruples grade ≥3 toxicity and has not yet shown clear benefits in hard endpoints like progression, cystectomy‑free, or overall survival.
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| Clinical Validation of the International Bladder Cancer Group's Intermediate-risk Non-muscle-invasive Bladder cancer Stratification Model
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| Jayant Siva, MD
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| This large, single‑center study validated the International Bladder Cancer Group’s five‑factor model for substratifying intermediate‑risk NMIBC into low‑, intermediate‑, and high‑risk groups. Patients with more IBCG risk factors had dramatically higher 3‑year recurrence and progression rates, strongly supporting use of this model to personalize surveillance and intravesical therapy intensity.
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| RECURxNCE-BCa, an Artificial Intelligence-based Tool to Predict Recurrence in Nonmuscle Invasive Bladder Cancer Using the WHO 2004/2022 Grading System
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| Jethro Kwong, MD, MSc
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| RECURxNCE‑BCa is an AI-based recurrence model for NMIBC built on 14 clinicopathologic variables and WHO 2004/2022 grading, trained in 3,797 patients and validated in 8,862 across 34 centers. It modestly outperformed EORTC, CUETO, and EAU calculators, showed good calibration and net clinical benefit, and, within intermediate‑risk disease, stratified patients into tertiles with clearly separated 5‑year recurrence risks, performing similarly to the IBCG model but with more even risk group distribution.
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| Translational Insights from CORE-008 Cohort A– Phase 2 Study of Intravesical Cretostimogene Grenadenorepvec in Patients with High-Risk BCG-Naïve Nonmuscle-Invasive Bladder Cancer.
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| Trinity Bivalacqua, MD, PhD
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| CORE-008 Cohort A showed that intravesical cretostimogene grenadenorepvec monotherapy achieved an 83.7% complete response rate in high-risk, BCG‑naïve NMIBC with CIS, with no progressions to muscle‑invasive or metastatic disease and no grade ≥3 treatment‑related adverse events. Translational data confirmed transient viral replication with effective clearance and robust but short‑lived urinary GM‑CSF expression, supporting its intended oncolytic and immunostimulatory mechanism.
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