Advancing Multidisciplinary Collaboration in MIBC Management

In this segment, panelists addressed the role of multidisciplinary teams and the integration of ctDNA testing in clinical decision-making for bladder cancer. They highlighted an emerging concern that many patients may be over-treated with perioperative therapy, given that some achieve durable remission with cystectomy alone. Panelists emphasized that patients who are ctDNA-negative at multiple timepoints—before neoadjuvant therapy, after therapy, and post-surgery—tend to have excellent outcomes, suggesting they may not require additional adjuvant treatment. They proposed that ctDNA could be instrumental in refining treatment intensity and potentially guiding bladder-preserving approaches for patients achieving clinical and molecular complete responses. However, they cautioned that further research is needed to define ctDNA’s utility in the post-neoadjuvant EV + pembrolizumab or Gem/Cis + durvalumab settings, where treatment decisions remain complex. Ultimately, ctDNA could help personalize therapy, identifying who truly benefits from extended systemic treatment.