Current Treatment Strategies for Muscle-Invasive Bladder Cancer

Karine Tawagi, MD University of Illinois Cancer Center

Key Points

• Chemoradiation is a treatment option for select patients with muscle-invasive bladder cancer (MIBC).

• For cisplatin-eligible patients, two neoadjuvant chemotherapy regimens—gemcitabine plus cisplatin and dose-dense MVAC—are FDA-approved.

• Adjuvant immunotherapy may be considered for patients who did not receive neoadjuvant chemotherapy or who have residual disease following cystectomy.

At the 2025 American Society of Clinical Oncology Annual Meeting, a panel of experts led by Rahul Gosain, MD, MBA, and Rohit Gosain, MD, explored the current treatment landscape of muscle-invasive bladder cancer (MIBC). 

 

Chemoradiation is a viable option for patients with MIBC who are deemed medically unfit for radical cystectomy, said Karine Tawagi, MD, University of Illinois Cancer Center, Chicago, Illinois.  

 

For patients eligible for surgery, treatment selection often is determined by cisplatin eligibility. The FDA approved two regimens for cisplatin-eligible patients: gemcitabine plus cisplatin and dose-dense MVAC (methotrexate, vinblastine, doxorubicin, cisplatin).  

 

In March 2025, the FDA approved a new perioperative immunotherapy approach based on the phase 3 NIAGARA trial data, which demonstrated significant improvements in event-free and overall survival. The regimen—comprising neoadjuvant durvalumab with gemcitabine-cisplatin, followed by cystectomy and adjuvant durvalumab—is now considered the standard of care for patients with cisplatin-eligible MIBC.