Dr Jonathan Anker speaks to ecancer about the phase 2 trial of pembrolizumab with response-guided bladder-sparing in patients with muscle-invasive bladder cancer.

This study evaluated pembrolizumab monotherapy following tumour resection, using response-guided strategies to determine whether patients could safely avoid radical cystectomy.

Results showed that over 40 percent of patients achieved a complete clinical response, and those patients were able to preserve their bladder without developing metastatic disease during follow-up.

Importantly, circulating tumour DNA proved to be a powerful early biomarker, with undetectable levels strongly associated with improved survival outcomes and a very low risk of metastasis.

Dr Anker highlights how combining immunotherapy with ctDNA monitoring could help personalise treatment, allowing select patients to safely avoid major surgery while maintaining excellent cancer control.