# Novel Immune Checkpoint Inhibitor and Antibody–Drug Conjugate Approaches in the Perioperative Management of Muscle-Invasive Bladder Cancer

## TL;DR

This paper reviews how immunotherapy and antibody-drug conjugates are changing treatment for muscle-invasive bladder cancer before and after surgery.

## Contribution

The paper provides a review of recent clinical trials and treatment shifts involving immune checkpoint inhibitors and antibody-drug conjugates in muscle-invasive bladder cancer.

## Key findings

- Immunotherapy and antibody-drug conjugates are now standard in perioperative care for muscle-invasive bladder cancer.
- Combination therapies improve survival outcomes in advanced urothelial carcinoma.
- Ongoing trials may further change treatment approaches for this cancer type.

## Abstract

The approach to treating muscle-invasive bladder cancer is shifting toward immunotherapy-based regimens and increasing use of antibody drug conjugates before and after surgery. In this paper, we review the key studies that led to these shifts in the perioperative management of muscle-invasive bladder cancer.

Immune checkpoint inhibitors and antibody drug conjugate combinations have revolutionized the management of patients with advanced and metastatic urothelial carcinoma, offering unprecedented survival outcomes. These treatments are now moving into earlier stages of disease, including perioperative treatments for patients with muscle-invasive bladder cancer planning for curative-intent radical cystectomy. In this setting, there are now standard-of-care options for adjuvant immune checkpoint inhibitors with or without prior neoadjuvant chemotherapy, perioperative immune checkpoint plus cytotoxic chemotherapy combinations, and perioperative immune checkpoint inhibitor plus antibody drug conjugate combinations. This review will evaluate key clinical trials that led to modern standards of care involving these classes of drugs and highlight ongoing clinical trials that may further shift treatment paradigms for muscle-invasive bladder cancer. Key efficacy and toxicity considerations will be reviewed, and available evidence for biomarkers will be evaluated. As immune checkpoint inhibitors and antibody drug conjugates continue to demonstrate improved outcomes across the spectrum of bladder cancer treatment, understanding their role in the muscle-invasive disease state is crucial to managing patients with this condition.