Bladder preservation after neoadjuvant therapy – 2021 IBCN updates part 1.

• Up to 50% of patients undergoing cystectomy are clinically understaged. • Identifying responders to neoadjuvant therapy is vital for bladder preservation. • We need precise definitions of clinical response and associated survival outcomes. • DNA damage response gene alterations are promising predictive markers. The morbidity associated with radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) has fueled investigations into the feasibility of bladder preservation strategies after a favorable clinical response to neoadjuvant therapy (NAT). Identifying optimal candidates for bladder preservation is predicated on our ability to identify tumors with inherent cisplatin sensitivity and accurately stage patients before and after NAT. In the present review, we evaluate the accuracy and limitations of contemporary staging modalities and investigate clinical outcomes in patients with MIBC who were managed with bladder preservation after NAT. Lastly, we discuss the predictive role of cisplatin-sensitizing DNA damage response (DDR) gene alterations as a foundational component to current prospective clinical trials evaluating bladder preservation in the setting of MIBC. [ABSTRACT FROM AUTHOR]