Dr Efstathiou on the Role of Tri-Modality Therapy in MIBC

Jason Efstathiou, MD, DPhil, radiation oncologist, professor, radiation oncology, Harvard Medical School; vice-chair, Faculty & Academic Affairs, director, Genitourinary Service, Department of Radiation Oncology; clinical co-director, The Claire and John Bertucci Center for Genitourinary Cancers, Massachusetts General Hospital, discusses the current and potential role for tri-modality therapy (TMT) in patients with muscle-invasive bladder cancer (MIBC).

TMT has emerged as an effective treatment strategy for patients diagnosed with MIBC, providing them with the opportunity to preserve their bladders, Efstathiou begins. This approach involves the complete transurethral resection of the bladder tumor followed by concurrent chemoradiation therapy.

National Comprehensive Cancer Network (NCCN) guidelines currently recommend TMT as a category 1 treatment option for patients with stage II and IIIA MIBC, Efstathiou reports. However, TMT may not be suitable for all patients, he notes. Careful consideration of individual factors is essential for treatment decision-making, and informed discussions should be had with eligible patients to determine if TMT aligns with their treatment goals and preferences, Efstathiou states. Multidisciplinary collaboration involving urologists, medical oncologists, and radiation oncologists is also paramount in the decision-making process regarding TMT, Efstathiou adds. He emphasizes that a collaborative approach ensures that patients receive comprehensive evaluation and personalized recommendations.

Although most research on the efficacy of TMT is in MIBC, this approach has potential applications in high-risk recurrent non-MIBC, Efstathiou continues. Ongoing clinical trials are exploring the utility of radiation in other disease states, such as oligometastatic bladder cancer. This has also prompted investigations into the feasibility and efficacy of using radiation directed at both the primary tumor site and metastatic lesions, he says, adding that data are emerging in these settings.

Overall, continued research and multidisciplinary collaboration are essential in further elucidating the optimal utilization of TMT across various clinical scenarios in bladder cancer management, Efstathiou concludes.