Localized · muscle-invasive bladder cancer
“There are new drugs. Do I still have to lose my bladder?”
EV + pembrolizumab became the peri-operative standard for every muscle-invasive bladder cancer in 2026. More than half of patients have no tumour left at surgery. Removing the bladder is still the default, with a urinary diversion for life.
87%
of patients on EV + pembrolizumab still underwent radical cystectomy in EV-304
Galsky, NEJM 2026 · pCR 56–57% in EV-303 and EV-304Cohort A bladder-sparing
- 4 cycles of REVAC-DXd to deepen the response.
- Restaging with MRI, cystoscopy, re-TURBT biopsies and cytology.
- Complete clinical response: chemoradiation (BC2001) instead of cystectomy, then 6 cycles of Dato-DXd. Otherwise, cystectomy.
Goal cCR 55% → 75% · 24 then 36 patients