Muscle-invasive bladder cancer (MIBC) treatment is undergoing major changes after nearly two decades of limited progress. Traditional treatment relied on surgery or radiation combined with cisplatin-based chemotherapy, but newer immunotherapies and targeted drugs are improving outcomes and reshaping care.
Clinical trials have shown strong benefits from immune checkpoint inhibitors such as Nivolumab, Pembrolizumab, and Durvalumab. Researchers also found that combining Enfortumab Vedotin with pembrolizumab improved response rates and survival in perioperative treatment, even without platinum-based chemotherapy.
Scientists are now exploring bladder-sparing strategies using radiation and immunotherapy combinations. Biomarkers including circulating tumor DNA (ctDNA), FGFR3 mutations, and HER2 overexpression are helping doctors identify which patients may benefit most from targeted therapies and personalized treatment approaches.