GU Cancers 2026 | Refining patient selection for bladder preservation with ctDNA-guided treatment
Pooja Ghatalia, MD, Fox Chase Cancer Center, Philadelphia, PA, discusses the evolving role of neoadjuvant therapy in muscle-invasive bladder cancer (MIBC), which now includes therapies such as enfortumab vedotin and pembrolizumab. Results from the RETAIN-2 trial (NCT04506554) highlight the importance of incorporating immunotherapy, and circulating tumor DNA (ctDNA) clearance is likely to improve with more efficacious neoadjuvant regimens. This interview took place at the 2026 ASCO GU Cancers Symposium in San Francisco, CA.
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Transcript
As I mentioned that, you know, I think in the neoadjuvant setting, it’s not just immunotherapy, chemotherapy, but now we also are expecting to have infortumab, viruton, and pembrolizumab in the neoadjuvant setting. And so all of this data would sort of have to be put in context with these newer neoadjuvant therapies. We did see in RETAIN-2 trial that the results were improved in terms of lesser recurrence in the active surveillance patients, both locally and metastases, compared to RETAIN-1...
As I mentioned that, you know, I think in the neoadjuvant setting, it’s not just immunotherapy, chemotherapy, but now we also are expecting to have infortumab, viruton, and pembrolizumab in the neoadjuvant setting. And so all of this data would sort of have to be put in context with these newer neoadjuvant therapies. We did see in RETAIN-2 trial that the results were improved in terms of lesser recurrence in the active surveillance patients, both locally and metastases, compared to RETAIN-1. So I think incorporating immunotherapy is a very important component. Such data were also seen in other trials. For example, in the HCRN trial, which involved gemcitabine, cisplatin, and nivolumab, where outcomes were better than what we have seen with RETAIN-1 in terms of lesser recurrences. So I do think that immunotherapy is a key component. But I also think that these results from ctDNA are generalizable in other settings, and we’ll hopefully see more ctDNA clearance with better neoadjuvant, stronger, more efficacious regimens.
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