It’s going to really change the way that we think about the adjuvant paradigm in bladder cancer. So, you know, traditionally we would use clinical pathologic risk tools to try to understand who should have treatment after bladder removal. I think with the ctDNA findings, it changes the way that we think. So we’re now maybe moving from a treat-all type situation to treat those with evidence of molecular disease...
It’s going to really change the way that we think about the adjuvant paradigm in bladder cancer. So, you know, traditionally we would use clinical pathologic risk tools to try to understand who should have treatment after bladder removal. I think with the ctDNA findings, it changes the way that we think. So we’re now maybe moving from a treat-all type situation to treat those with evidence of molecular disease. But it’s very complicated because obviously we have multiple adjuvant regimens, we have neoadjuvant regimens, we have these sandwiches, we have new data from ESMO on enfortumab vedotin and pembrolizumab. So the landscape’s complicated, and what we don’t know is that these observations that are specifically seen in the context of atezolizumab, do they extend to all classes of therapies and all contexts of ctDNA detections? We’re going to have to actually test that, perhaps in the correlative samples from those other trials and maybe even other trials. But the crux of the matter is this is concept defining and potentially really important for changing the paradigm of treatment in bladder cancer.
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