Ep. 2: Coordinating Systemic Therapy and Radical Cystectomy in Muscle-Invasive Bladder Cancer
Key Points
-
Multidisciplinary collaboration between medical oncologists and urologists is essential to ensure that patients receiving perioperative systemic therapy safely proceed to radical cystectomy.
-
Available data suggest that perioperative systemic regimens do not significantly compromise surgical outcomes, although strong tumor responses may increase fibrosis and surgical complexity.
-
Clinical decision-making may depend on factors such as cisplatin eligibility and tumor variant histologies, which may influence the optimal treatment strategy.
Surgical Considerations in the Era of Perioperative Therapy
During a Clinical Insights session held at an event coinciding with the 2026 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, experts examined how emerging systemic therapies are reshaping the management of muscle-invasive bladder cancer (MIBC). Rahul Gosain, MD, MBA, of the Wilmot Cancer Institute, and Rohit Gosain, MD, of Roswell Park Comprehensive Cancer Center, moderated the panel, which included Sia Daneshmand, MD, of the Keck School of Medicine of USC; Matt Galsky, MD, of Mount Sinai; Shilpa Gupta, MD, of Cleveland Clinic; and Chad Reichard, MD, of Urology of Indiana.
Dr. Daneshmand noted that current evidence suggests new systemic regimens expand treatment options but do not significantly alter surgical outcomes. Radical cystectomy carries a substantial risk of postoperative complications, and available data indicate that perioperative systemic therapy, including immunotherapy-based combinations, does not meaningfully increase these risks.
In some cases, however, highly effective systemic therapy may produce significant tumor responses, leading to fibrosis that can make surgery technically more challenging. Dr. Daneshmand suggested that this phenomenon likely reflects treatment response rather than regimen-specific toxicity.
Importance of Multidisciplinary Coordination
Panelists highlighted that effective implementation of perioperative therapy depends on strong collaboration between oncology and urology teams. Dr. Reichard emphasized that clear communication and careful timing of surgery are critical components of patient management. Variability in treatment completion, such as interruptions during neoadjuvant therapy, may necessitate earlier surgical intervention, making coordination between specialties essential to avoid delays in definitive care.
Clinicians must also consider biological factors that could influence treatment selection. Dr. Galsky pointed to ongoing uncertainty regarding the optimal management of urothelial cancers with variant histologies, which may demonstrate variable expression of therapeutic targets and differential responsiveness to available systemic therapies.