Would you consider neoadjuvant chemotherapy for patients with muscle-invasive bladder cancer who are cisplatin-ineligible?
What initial treatment approach do you generally recommend for cisplatin-ineligible MIBC fit for cystectomy?
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Prior to 2025, the answer to this question would be no in the United States. Cisplatin was considered the most active drug to include in neoadjuvant therapy of MIBC prior to radical cystectomy, and for patients who were not eligible to receive it due to medical conditions or renal function, or refused it, the standard had been to proceed to radical cystectomy.
That changed in October 2025 when the results of KEYNOTE-905 were presented at ESMO.
KEYNOTE-905 was initiated in 2019 and compared perioperative pembrolizumab with radical cystectomy and pelvic lymph node dissection versus surgery alone. A third group receiving perioperative EV+P was added in 2020, based on promising results in the metastatic setting. In 2022, the inclusion criteria ...
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