Ep. 54 Clinical Advances in Muscle Invasive Bladder Cancer with Dr. Tyler Stewart

Don’t miss the “curative window”! This episode takes a closer look at how evolving perioperative strategies and biomarker integration are changing bladder cancer care, with a focus on preserving opportunities for cure. Jun Gong hosts Tyler Stewart to review key bladder cancer updates from ASCO Genitourinary Cancers Symposium 2026. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction01:50 - KEYNOTE-905 Overview07:09 - Practice-Changing Takeaways13:28 - Bladder Preservation Trials16:06 - ctDNA Biomarker Updates21:16 - Using ctDNA in Clinic28:48 - Metastatic ADC Data33:36 - Wrap-Up --- More about this episode The discussion begins with KEYNOTE-905/EV-303 in cisplatin-ineligible muscle-invasive bladder cancer, where perioperative enfortumab vedotin plus pembrolizumab demonstrated improvements in event-free and overall survival. This is followed by KEYNOTE-B15, which compares perioperative EVP with gemcitabine/cisplatin and identifies EVP as the first non-platinum regimen to outperform cisplatin-based therapy. Implications for clinical adoption are considered, including the potential for EVP to extend across cisplatin eligibility groups, unresolved questions regarding perioperative duration and adjuvant use, and the need to avoid premature de-escalation outside of trial settings.The latter portion of the episode focuses on biomarker-driven decision-making. Data from RETAIN-2 highlight the prognostic value of post-neoadjuvant ctDNA positivity for systemic relapse risk, while underscoring its limitations in detecting intravesical recurrence. Complementary findings from NIAGARA suggest that urine tumor DNA may more accurately reflect local disease burden and pathologic complete response. Together, these studies frame an evolving role for circulating and urine-based biomarkers in guiding surveillance, treatment selection, and timing—central considerations in maintaining the curative window. --- Resources KEYNOTE-B15https://ascopubs.org/doi/10.1200/JCO.2026.44.7_suppl.LBA630 KEYNOTE-905https://www.nejm.org/doi/abs/10.1056/NEJMoa2511674 EV-302 Clinical Trialhttps://www.nejm.org/doi/full/10.1056/NEJMoa2312117