Neoadjuvant chemotherapy (NAC) followed by bladder-sparing trimodality therapy (TMT) is an emerging treatment option for selected patients with muscle-invasive bladder cancer (MIBC), but long-term outcome data remain limited.
MIBC patients treated with 3-4 cycles of cisplatin-based NAC followed by TMT (maximal TURBT and concurrent radiation with weekly cisplatin) at 2 Canadian cancer centers from 2008 to 2017 were retrospectively reviewed. This updated analysis assessed median disease-free survival (DFS), overall survival (OS), bladder-intact DFS (BI-DFS), and metastasis-free survival (MFS) using Kaplan-Meier methods.
The study cohort included 56 patients (79% male; median age 72 [range, 45-87]) with stage II (59%), stage III (36%), and node-positive disease (13%); 38% had mixed histology. At baseline, 24% had eGFR < 60 mL/min/1.73 m², and 25% had hydronephrosis. NAC completion rate was 95%. All patients completed radiotherapy, and 88% received > 60% of planned concurrent cisplatin. After a median follow-up of 91 months, 23 patients (41%) recurred, including 11 local recurrences (20%), 8 requiring salvage cystectomy (14%), and 12 distant recurrences (21%). Median DFS was 48.9 months (95% CI, 25.3-73.4), and median OS was 96.5 months (95% CI, 56.6-126.4). Patients without residual tumor on post-NAC cystoscopy (31/43 patients) had numerically longer median DFS (73 months) and OS (126 months).
Cisplatin-based NAC followed by TMT can provide durable disease control in selected patients with MIBC, including those with high-risk features downstaged by NAC. Prospective studies integrating novel systemic therapies and biomarkers, including ctDNA and urinary tumor DNA, may further optimize bladder-sparing approaches.
Clinical genitourinary cancer. 2026 Jun 17 [Epub ahead of print]
Meghan E Mahoney, Di Maria Jiang, Nely Díaz-Mejía, Eshetu G Atenafu, Peter Chung, Alexandre Zlotta, Nimira Alimohamed, Neil Fleshner, Gregory Lo, Pawel Zalewski, Amin Kay, Girish Kulkarni, Alejandro Berlin, Srikala S Sridhar
Division of Medical Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, ON., Division of Biostatistics, Department of Biostatistics, University Health Network, DLSPH, University of Toronto, Toronto, ON., Division of Radiation Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, ON., Division of Urology, Princess Margaret Cancer Center, University of Toronto, Toronto, ON., Arthur Child Cancer Centre, University of Calgary, Calgary, AB., Medical Oncology, Durham Regional Cancer Centre, Oshawa, ON., Division of Medical Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, ON. Electronic address: .