A New Standard of Care for Muscle-Invasive Bladder Cancer

Patients with muscle-invasive bladder cancer (MIBC) are at high risk for systemic failure following radical cystectomy. Cisplatin-based neoadjuvant chemotherapy — long a standard of care — provides a modest survival improvement, and not all patients can receive this therapy. In patients with metastatic urothelial cancer, enfortumab vedotin plus pembrolizumab (EVP) previously demonstrated improvement in overall survival compared with gemcitabine plus cisplatin (GC). Now, investigators have compared perioperative (neoadjuvant and adjuvant) EVP to neoadjuvant GC in ≈800 patients with cisplatin-eligible MIBC in the international, industry-funded, phase 3, randomized KEYNOTE-B15/EV-304 study.