Ep. 54 Clinical Advances in Muscle Invasive Bladder Cancer with Dr. Tyler Stewart

Don’t miss the “curative window”! This episode takes a closer look at how evolving perioperative strategies and biomarker integration are changing bladder cancer care, with a focus on preserving opportunities for cure. Jun Gong hosts Tyler Stewart to review key bladder cancer updates from ASCO Genitourinary Cancers Symposium 2026.

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Timestamps

00:00 - Introduction
01:50 - KEYNOTE-905 Overview
07:09 - Practice-Changing Takeaways
13:28 - Bladder Preservation Trials
16:06 - ctDNA Biomarker Updates
21:16 - Using ctDNA in Clinic
28:48 - Metastatic ADC Data
33:36 - Wrap-Up

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More about this episode

The discussion begins with KEYNOTE-905/EV-303 in cisplatin-ineligible muscle-invasive bladder cancer, where perioperative enfortumab vedotin plus pembrolizumab demonstrated improvements in event-free and overall survival. This is followed by KEYNOTE-B15, which compares perioperative EVP with gemcitabine/cisplatin and identifies EVP as the first non-platinum regimen to outperform cisplatin-based therapy. Implications for clinical adoption are considered, including the potential for EVP to extend across cisplatin eligibility groups, unresolved questions regarding perioperative duration and adjuvant use, and the need to avoid premature de-escalation outside of trial settings.
The latter portion of the episode focuses on biomarker-driven decision-making. Data from RETAIN-2 highlight the prognostic value of post-neoadjuvant ctDNA positivity for systemic relapse risk, while underscoring its limitations in detecting intravesical recurrence. Complementary findings from NIAGARA suggest that urine tumor DNA may more accurately reflect local disease burden and pathologic complete response. Together, these studies frame an evolving role for circulating and urine-based biomarkers in guiding surveillance, treatment selection, and timing—central considerations in maintaining the curative window.

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Resources

KEYNOTE-B15
https://ascopubs.org/doi/10.1200/JCO.2026.44.7_suppl.LBA630

KEYNOTE-905
https://www.nejm.org/doi/abs/10.1056/NEJMoa2511674

EV-302 Clinical Trial
https://www.nejm.org/doi/full/10.1056/NEJMoa2312117