From the Guidelines
The prognosis for bladder cancer invading the muscular layer with no lymph node involvement after immunotherapy is generally favorable, with a complete response rate of 41% at 3 months, as shown in the KEYNOTE-057 trial. When considering the management of patients with muscle-invasive bladder cancer, it is crucial to prioritize treatments that improve morbidity, mortality, and quality of life. According to the ESMO clinical practice guideline for diagnosis, treatment, and follow-up of bladder cancer 1, the management of muscle-invasive disease involves various approaches, including radical cystectomy with pelvic lymphadenectomy, multimodality bladder-sparing treatments, and systemic anticancer therapy. For patients with high-risk non-muscle-invasive bladder cancer (NMIBC) who are unresponsive to bacillus Calmette-Guerin (BCG), immunotherapy with pembrolizumab can be considered, as it has shown a complete response rate of 41% at 3 months in the KEYNOTE-057 trial 1. Key points to consider in the management of these patients include:
- Regular surveillance with cystoscopy, urine cytology, and imaging studies to monitor for disease recurrence
- The potential benefits and risks of radical cystectomy, including the impact on quality of life
- The role of neoadjuvant chemotherapy with cisplatin-based regimens in improving survival outcomes
- The importance of monitoring for delayed immune-related adverse events following immunotherapy. Overall, the prognosis for bladder cancer invading the muscular layer with no lymph node involvement after immunotherapy is favorable, and treatment should be individualized based on patient-specific factors and the latest evidence-based guidelines 1.
From the Research
Prognosis for Bladder Cancer
- The prognosis for bladder cancer invading the muscular layer with no lymph node involvement after immunotherapy is a complex topic, with various studies providing insights into the effectiveness of different treatment approaches 2, 3, 4, 5, 6.
Treatment Approaches
- Neoadjuvant chemotherapy followed by radical cystectomy is a standard treatment approach for muscle-invasive bladder cancer, with studies showing improved overall survival rates compared to radical cystectomy alone 2, 5.
- Immunotherapy is a promising tool in the treatment of bladder cancer, with studies demonstrating its potential in improving overall survival rates 3, 4.
- The combination of neoadjuvant immunotherapy and chemotherapy has been shown to achieve higher complete response rates and pathological downstaging rates compared to neoadjuvant immunotherapy or chemotherapy alone 4.
Factors Affecting Prognosis
- The number of neoadjuvant chemotherapy cycles and the addition of adjuvant chemotherapy may have limited effects on overall survival rates in patients with muscle-invasive bladder cancer 6.
- Pathologic high-risk factors, such as ypT2-4, pT3-4, or pN+, and cisplatin ineligibility are significantly associated with poor overall survival rates 6.
Immunotherapy and Bladder Cancer
- Immunotherapy has been shown to be effective in the treatment of bladder cancer, with studies demonstrating improved overall survival rates and complete response rates 3, 4.
- The development of predictive and prognostic biomarkers is necessary to bring out the true potential of immunotherapeutic agents in the treatment of bladder cancer 3.