For neoadjuvant treatment of muscle invasive bladder cancer, are you utilizing durvalumab plus gemcitabine cisplatin over dose dense or accelerated MVAC?  

Neoadjuvant Dose Dense MVAC (ddMVAC) has been shown to be safe and effective in MIBC. However, given the different side effect profile compared to cisplatin gemcitabine, especially in terms of bone marrow suppression, cardiotoxicity, and neurotoxicity, the majority of patients are not receiving ddMV...

I have used gem cis for the majority of my patients; very occasionally, I have used ddMMVAC for the fit patients. The significant side effects profile for ddMVAC dampens my enthusiasm to use it. I would prefer using gem cis durva over ddMVAC, unless there is a contraindication to adding immunotherap...

Our academic practice covers a wide mix of patients, frequently with many comorbidities – this makes it challenging to do dose dense regimens, however, this is certainly a regimen we have used in fitter patients.