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.

 

End of Award Update – July 2025

 

Results

With the support of the CANTRAIN and Michael Smith Health Research BC fellowship, I participated in a structured series of training activities designed to enhance knowledge and skills in clinical trial research. These included online modules and group-based sessions on trial methodology, regulatory requirements, and clinical trial good practice. I was also matched with an experienced mentor, with whom I virtually met monthly to discuss both the scientific and practical aspects of launching an investigator-initiated clinical trial.

 

Impact

The support of this fellowship contributed to the development and initiation of the NeoBLAST trial, now actively recruiting in British Columbia. The trial explores bladder preservation strategies for patients with muscle-invasive bladder cancer who achieve a complete response after neoadjuvant treatment, addressing a critical gap in care. In addition to contributing to lauch of this exciting clinical trial, this project will also helped build a foundation for translational research and patient-centered innovation in urologic oncology in BC.

 

Potential Influence

NeoBLAST has the potential to change clinical practice by identifying patients who may avoid radical cystectomy without compromising oncologic outcomes. If successful, the trial could inform national and international guidelines on bladder cancer management. Additionally, correlative studies will also be done to investigate other potential biomarker of response and surveillance of recurrence of disease.

 

Future Research

The current Phase II feasibility study will be enrolling patient accros the province, and we will plan to expend to into a multi-centre Phase III trial pending proof of feasibility (Phase II) and additional funding. We are also pursuing translational studies on biospecimens collected through the trial to explore use of urine derive tumor DNA (utDNA), radiomics and additional immunologic markers with collaborators from the Vancouver Prostate Centre.