Enrique Grande, Director of the Medical Oncology Department at Quirónsalud, and Adjunct Professor at The University of Texas MD Anderson Cancer Center, shared a post on LinkedIn:
“Muscle-invasive bladder cancer: is trimodal therapy underused?
Radical cystectomy remains the standard of care for MIBC. The data are solid. The oncological outcomes, in experienced hands, are well established.
But trimodal therapy – maximal TURBT followed by concurrent chemoradiation – is a valid bladder-sparing alternative in carefully selected patients. And I think we need to have an honest conversation about whether we are offering it as often as we should.
A few questions I keep coming back to:
- Are we selecting patients for TMT based on evidence – or based on institutional bias? The data support TMT in patients with unifocal disease, no hydronephrosis, complete or near-complete TURBT, and adequate bladder function. That is a meaningful subset of our MIBC population.
- Is the conversation about bladder preservation happening early enough? In my experience, patients are rarely presented with TMT as a genuine alternative. Often, cystectomy is framed as the only real option – and that framing shapes the decision.
- What does quality of life look like after each approach? Long-term functional outcomes after TMT – when the bladder responds well – can be very good. We need to be sharing this data with patients, not just with each other at conferences.
- How does the new systemic therapy landscape change things? With more active perioperative regimens – nivolumab, pembrolizumab, EV-based combinations under investigation – both pathways are evolving. The integration of immunotherapy into TMT protocols is an area that deserves more attention.
I am not arguing that TMT is always the right answer. I am arguing that it deserves a real seat at the table – in the multidisciplinary discussion, and in the conversation with the patient.
Bladder preservation is not just about the organ. It is about what that organ means to the person who has it.”
SAKK 06/19: Intravesical rBCG Added to Chemoimmunotherapy in Muscle-Invasive Bladder Cancer
