Neoadjuvant Therapy in Muscle-Invasive Bladder Cancer: Current Evidence, Evolving Strategies, and Future Directions.

Authors

Jackson Eber, Justin T Matulay

Published in

The Urologic clinics of North America. Volume 53. Issue 4. Pages 517-526. Epub Jul 30, 2026.

Abstract

Neoadjuvant therapy is now a cornerstone of muscle-invasive bladder cancer management, evolving from traditional cisplatin-based chemotherapy to novel immunotherapy and antibody-drug conjugate combinations. While dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin remains the cytotoxic standard, the phase III NIAGARA and KEYNOTE 905 trials have established new benchmarks for cisplatin-eligible and ineligible populations, respectively. Furthermore, the integration of molecular subtyping, DNA damage repair biomarkers, and liquid biopsies (circulating tumor DNA) is facilitating a shift toward precision medicine. These advancements aim to optimize pathologic response, improve overall survival, and identify candidates for bladder-sparing approaches.

PMID:
42823043
Bibliographic data and abstract were imported from PubMed on 02 Oct 2026.

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