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GU Cancers 2026 | De-escalating therapy after major neoadjuvant response in MIBC

Andrea Necchi, MD, IRCCS San Raffaele Hospital and Scientific Institute, Milan, Italy, highlights the potential to de-escalate treatment intensity for patients who have achieved a major response to neoadjuvant therapy in muscle-invasive bladder cancer (MIBC). New strategies that may allow patients to skip radical cystectomy and chemoradiation are additionally needed, but newly investigated therapies, such as intravesical gemcitabine or TAR-200, may provide opportunities for this patient population. This interview took place at the 2026 ASCO GU Cancers Symposium in San Francisco, CA.

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Transcript

Yeah, there is clearly a path that is suggested by the patients whenever they refuse to undergo a radical cystectomy after, primarily after a major response, deeper response, almost complete response or near complete response after neoadjuvant therapy of any kind. Trying to de-escalate a little bit the intensity of treatment that we can provide to the patients in the long run, including combination therapies provided in the adjuvant phase, and particularly trying to identify new strategies that may enable patients to skip radical cystectomy and possibly also chemoradiation...

Yeah, there is clearly a path that is suggested by the patients whenever they refuse to undergo a radical cystectomy after, primarily after a major response, deeper response, almost complete response or near complete response after neoadjuvant therapy of any kind. Trying to de-escalate a little bit the intensity of treatment that we can provide to the patients in the long run, including combination therapies provided in the adjuvant phase, and particularly trying to identify new strategies that may enable patients to skip radical cystectomy and possibly also chemoradiation. In this regard, newly investigated therapies and gemcitabine IDR or Tart-200 is pretty well positioned to become a possible opportunity for this patient population so expanding a little bit beyond the boundaries of our visage and responsive CIS which is currently the FDA label of the drug

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