Overview
Muscle-invasive bladder cancer is an aggressive subtype of bladder cancer, and the standard treatment for eligible patients is chemotherapy (cisplatin-based neoadjuvant chemotherapy) followed by surgery. However, many patients cannot receive cisplatin due to kidney problems, poor overall health, or other medical conditions—leaving them with limited treatment options and worse outcomes.
Using the Flatiron Health Panoramic Database, comprising >40K patients with bladder cancer, researchers analyzed data from over 5,000 patients with muscle-invasive bladder cancer who underwent surgery between 2015 and 2025. Among them, 10% were deemed cisplatin-ineligible. Researchers found these ineligible patients had significantly worse survival than those who could receive cisplatin. Notably, nearly half of the cisplatin-ineligible patients still received cisplatin-based chemotherapy, likely because they were carefully selected based on individual factors. These carefully selected ineligible patients who received chemotherapy showed improved survival compared to those who didn't receive it.
Why this matters
This research suggests that selected cisplatin-ineligible patients may benefit from treatment despite their medical limitations. Importantly, the therapeutic landscape in muscle-invasive bladder cancer is rapidly evolving, with recent peri-operative approvals such as enfortumab vedotin plus pembrolizumab expanding treatment options beyond traditional cisplatin-based approaches. The findings highlight an important opportunity to improve outcomes for this underserved population through thoughtful, individualized treatment decisions, while emphasizing the need for better therapeutic strategies and further research to optimize care for patients who cannot receive standard treatments.