Ashish Kamat: Is Surveillance Safe for Bladder Cancer Patients After pCR?

Ashish Kamat, Professor and Director of Urologic Oncology Fellowship at MD Anderson Cancer Center,  shared a post on LinkedIn:

“Love the candid discussion that this tweet has generated! Posted prior to flight, now back after FIFA26 and Wimbledon, so let me post some of my thoughts on this։

1.  Shared decision making is only shared decision making when patients are informed of all their choices.
   As we showed in our global patient survey, the majority of patients are never told there is any option other than radical cystectomy. You cannot call it a choice if only one path was ever offered.
2.  Next, There is a persistent literature suggesting ‘poor outcomes with TMT/XRT.’ Much of it is built on prognostic factors that are unfavorable for RC and for radiation alike, then attributed selectively to bladder preservation.
   We attempted to correct for exactly this in our publication.
3. However, the point I was trying to make is that – in the absence of data (and until trials are completed) we cannot say that the excellent pCR results from EV303, EV304 and even NIAGRA equate with omitting local consolidation – which in these studies was radical cystectomy.
   Extrapolating from pCR to ‘skip the operation’ is a leap of faith. Not least of which is equating cCR with pCR. And if anyone falls, it is the patient, not us who suffers.
   If we are wrong, we say ‘oops back to the drawing board.’ The patient, now potentially facing mUC, as we have seen in prior attempts like RETAIN, does not get a second chance at life.
4.  The trials to answer this question are underway. EV-209 (NCT07475806) for surveillance with predefined salvage triggers. ARCHER and BRIGHT for the safety and efficacy of local therapy in this exact setting.

The answer is coming. So rather than quietly adopting surveillance as standard of care on the strength of pCR alone, let’s enroll these patients on the protocols designed to tell us whether it is actually safe. pCR is a good outcome but it is not proof of cure. Let’s wait for the data we are actively generating.

PS: Thanks Yuksel Urun for the poll that ignited this discussion!”

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