Bladder-preserving trimodality therapy for muscle-invasive bladder cancer: current state-of-the-art.

INTRODUCTION: Despite major advances in the management of bladder cancer over the past decade, including practice-changing studies with immune checkpoint inhibitors and antibody drug conjugates (ADC), patients continue to desire treatment strategies that not only improve survival but also allow them to retain their bladder. Trimodal therapy (TMT), consisting of maximal transurethral resection of bladder tumor (TURBT), radiation, and chemotherapy, remains an important option for appropriately selected patients.

AREAS COVERED: We discuss the current standard of care for the management of localized bladder cancer with a focus on TMT including chemotherapy regimens used in TMT, the role of maximal TURBT, potential biomarkers, and the effect of histologic subtype on outcomes. We also provide updates on important upcoming trials that will hopefully translate into new treatment options.

EXPERT OPINION: In appropriately selected patients, TMT is an alternative to radical cystectomy in the management of muscle invasive bladder cancer (MIBC). All patients with MIBC should be evaluated by a multidisciplinary team consisting of urology, medical oncology, and radiation oncology to determine the best treatment plan for an individual patient. Ongoing trials are studying new regimens to provide additional options for bladder preservation.