AHCI Grand Rounds Recorded 7-15-2026: Management of Bladder Cancer

Recorded Presentation from AHCI Grand Rounds. Expires 7/14/2027. Duration = 48 minutes

Dr. Grant Wintheiser discusses how the management of muscle-invasive bladder cancer (MIBC) has changed dramatically after decades of limited therapeutic advances, evolving from a standard approach of neoadjuvant cisplatin-based chemotherapy followed by radical cystectomy and selective adjuvant nivolumab toward more effective perioperative strategies. He shares that historically, cisplatin-based regimens improved overall survival by approximately 510% and achieved pathologic complete response (pCR) rates of 2540%, but recurrence remained common, prompting interest in biomarkers such as circulating tumor DNA (ctDNA), which has emerged as a powerful predictor of recurrence risk and survival. He updates on how recent phase III trials have established perioperative enfortumab vedotin plus pembrolizumab (EV-Pembro) as a new standard of care for both cisplatin-eligible and cisplatin-ineligible patients, improving pCR rates to approximately 5560% while significantly enhancing event-free and overall survival. At the same time, bladder-preservation approaches, including trimodality therapy and investigational active surveillance strategies, are gaining interest, although ctDNA alone is insufficient to detect residual bladder disease and may need to be combined with urinary tumor DNA, cystoscopy, and imaging for optimal patient selection. He stresses the importance of clinicians being prepared to monitor and manage EV-related toxicities, particularly rash, peripheral neuropathy, ocular disorders, and hyperglycemia, while ongoing studies seek to define the ideal duration of therapy and identify patients who may safely avoid cystectomy.

1. Differentiate historical and current standards of care for muscle invasive bladder cancer (MIBC), including the role of cisplatin based neoadjuvant chemotherapy, radical cystectomy, adjuvant immunotherapy, and perioperative enfortumab vedotin plus pembrolizumab (EVPembro).
2. Evaluate patient specific factors, including cisplatin eligibility, disease stage, comorbidities, and pathologic risk features, to select evidence based treatment approaches for patients with muscle invasive bladder cancer.
3. Interpret key outcomes from recent practicechanging clinical trials (EV302, EV303, EV304, CheckMate 274, and ctDNAguided studies) and apply these findings to contemporary treatment decisionmaking in MIBC.
4. Assess the clinical utility and limitations of circulating tumor DNA (ctDNA) and urinary tumor DNA as prognostic and diseasemonitoring tools for predicting recurrence risk, guiding adjuvant therapy considerations, and informing bladderpreservation strategies.
5. Develop individualized management plans that incorporate bladderpreservation approaches, including trimodality therapy and emerging active surveillance strategies, while recognizing appropriate patient selection criteria and management of common enfortumab vedotinassociated toxicities.

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Member Information

Role in activity

Nature of Relationship(s) / Name of Ineligible Company(s)

Grant Wintheiser, MD
Medical Oncologist
Allina Health Cancer Institute
Coon Rapids, MN

Faculty

Nothing to disclose

Joleen Hubbard, MD
Oncologist
AHCI Cancer Center Minneapolis ANW
Minneapolis, MN

Lead Physician

Advisor-Amgen, Inc. (Relationship has ended)|Advisor-AstraZeneca (Any division) (Relationship has ended)|Advisor-Bayer (Any division) (Relationship has ended)|Advisor-BeOne (Relationship has ended)|Advisor-GlaxoSmithKline (Relationship has ended)|Advisor-Taiho Pharmaceutical (Relationship has ended)|Grant or research support-Biontech|Grant or research support-C4 Therapeutics (Relationship has ended)|Grant or research support-Exact Sciences|Speakers Bureau-Incyte Corporation Incyte Corporation

Elizabeth Loach, MSN, APRN, CNS, AGCNS-BC, OCN
Manager of Nursing Practice and Clinical Education
Allina Health, Allina Health Cancer Institute
Saint Paul, MN

Nurse Planner

Nothing to disclose