Optimal therapeutic management for cN1 M0 bladder cancer consists of perioperative systemic therapy and radical cystectomy. For patients with cN2–3 M0 disease, evidence supports upfront systemic therapy, preferably with enfortumab vedotin + pembrolizumab. Consolidative locoregional therapy may be an option in selected responders. Questions remain regarding the optimal duration of systemic therapy and the role of biomarkers. Multidisciplinary expert opinion can be critical for informed shared decision-making.
Optimal therapeutic management for cN1 M0 bladder cancer consists of perioperative systemic therapy and radical cystectomy. For patients with cN2–3 M0 disease, evidence supports upfront systemic therapy, preferably with enfortumab vedotin + pembrolizumab. Consolidative locoregional therapy may be an option in selected responders. Questions remain regarding the optimal duration of systemic therapy and the role of biomarkers. Multidisciplinary expert opinion can be critical for informed shared decision-making.