GU Cancers 2026 | Systemic therapy advances and personalized bladder cancer treatment

Yeah, so I think that’s the key question at this point. So what we’re seeing is now a very rapid evolution of systemic therapy in bladder cancer. So first in a metastatic setting, but also seen at this meeting that the combination of Enfortumab Vedotin plus Pembrolizumab works really well in a neoadjuvant setting. So this will be the new standard. And given that with these new combinations, over 50% of patients have a pathological complete response and actually pretty good outcomes, we can understand that patients will be wondering, do I still need to have my surgery? At this point, we need to still advise to have the surgery as the complete treatment includes surgery. However, we could envision that with these new tools that are much more accurate in staging than what we’ve been doing previously, we can start doing trials and can start looking at, you know, some patients may not need any consolidative treatment if they really clear both their ctDNA and urinary tumor DNA and clinically seem to have a complete response. Whereas some patients may need still some additional treatment, but maybe not everybody needs to have a cystectomy. So in this way we can, I think in the future, stratify what kind of consolidative treatment patients still need. Also the group of patients who still have positive ctDNA after therapy, that’s the group that really needs better systemic therapy. So that’s also a group that we certainly have some work to do.

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