Active surveillance versus definitive local therapy for patients showing clinical complete response following neoadjuvant treatment for muscle invasive bladder cancer, a pilot-RCT.

This research is led by Dr. Marie-Pier St-Laurent, a urologic oncology fellow at the University of British Columbia (UBC) who will transitioning to faculty in July 2025, and under the mentorship of Dr. Peter Black and in collaboration with Dr. Bernie Eigl. This British Columbia-based project will investigates a novel and personalized treatment approach for patient with muscle-invasive bladder cancer through a pilot randomized clinical trial.

Invasive bladder cancer is typically treated with chemotherapy followed by bladder removal surgery, or the combination of chemotherapy and bladder radiation While effective, these treatments may often cause significant side effects. Studies and experience have shown that one-third of patients treated with chemotherapy before surgery have no detectable cancer left in their bladder, suggesting that maybe they could avoid invasive treatments. However, current methods cannot reliably identify these patients without removing their bladder.

This project integrates advanced imaging (MRI), repeat bladder biopsies, and novel biomarkers (liquid biopsies detecting circulating tumor DNA in blood, or ctDNA) to identify patients with no residual cancer. The NEO-BLAST trial will assess whether these patients can safely opt for active surveillance (with monitoring) versus the standard definitive bladder therapy (bladder removal or chemo-radiation).

If successful, this study could shift the paradigm in bladder cancer care, reducing treatment burden while improving patients’ quality of life. Supported by funding from the CIHR Catalyst Grant for SPOR Innovative Clinical Trials (iCT), this study could lay the groundwork for a pan-Canadian clinical trial and improve care delivery across BC by reducing surgeries and optimizing healthcare resources.