Miguel Bronchud, Veteran Cancer Clinician and Researcher, shared on LinkedIn:
“Excellent summary on the recent 2026 Guilford IUCS meeting shared by Dr Maria Natalia Gandur Quiroga from Argentina (Chief of the Division of Genitourinary Medical Oncology at the Angel H. Roffo Oncology Institute):
‘Integrating Loco-Regional and Systemic Approaches – in Metastatic Bladder Cancer’- courtesy of OncoDaily
In cisplatin-fit MIBC, perioperative treatment has clearly evolved. NIAGARA and KEYNOTE-B15/EV-304 both show meaningful event-free survival improvement with intensified perioperative strategies. Precise overall survival pending cost effectiveness estimates?
The question is increasingly not only which systemic regimen, but also who is the ideal candidate for bladder preservation versus radical cystectomy.
Favorable features for trimodality therapy include: unifocal cT2 disease, no hydronephrosis, no multifocal CIS, high surgical risk or a strong desire for bladder preservation.
Factors that may favor radical cystectomy include poor bladder function, prior pelvic RT, diffuse CIS and multifocal disease.
Maximal TURBT matters, particularly for downstaging, but retrospective data shown here suggest that maximal TUR was associated with downstaging rather than a clear OS advantage. Clinical complete response remains difficult to define with certainty.
Current assessment combines cystoscopy, TURBT/biopsy, urine cytology and imaging, but sampling error, interobserver variability and treatment-related tissue changes remain important limitations.
Future refinement will likely require standardized MRI, AI-based tools, urine tumor DNA, ctDNA and molecular biomarkers to improve confidence in response assessment.
Quality of life also matters of course .
Data from CISTO reinforce that bladder-sparing therapy and cystectomy may each offer different QoL advantages, underlining the importance of shared decision-making rather than a one-size-fits-all approach.
Key summary from the session: bladder cancer has lagged behind for decades, but the landscape is now changing rapidly through IO, ADCs, better diagnostics and more nuanced treatment selection.
Clinical takeaway: radical loco-regional treatment remains standard of care, but the future is increasingly marker-driven, response-adapted and personalized, with bladder preservation becoming a more sophisticated option for selected patients.”
Key Takeaways from IUCS26 Shared by Dr. María Natalia Gandur Quiroga
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