Dr. Bogdana Schmidt

I agree. And I do want to get back to your point. I think that's a really important point of path CR as an outcome here, because that is tricky, right? We know that even from old trials, SWOG trial, Nordic, et cetera, that when we were looking at neoadjuvant chemo in this setting, there is a PT0 rate from TUR alone, meaning no neoadjuvant treatment whatsoever, in the 12% to 15% range.

I agree. And I do want to get back to your point. I think that's a really important point of path CR as an outcome here, because that is tricky, right? We know that even from old trials, SWOG trial, Nordic, et cetera, that when we were looking at neoadjuvant chemo in this setting, there is a PT0 rate from TUR alone, meaning no neoadjuvant treatment whatsoever, in the 12% to 15% range.

And neoadjuvant chemo gets you 25% to 38%. There is that variability of did you get a good TUR? Was it in a location where you could have truly resected all of it? And those factors are really hard to account for. But I think to me, when I think about these things, I think that the distant metastatic potential is what I worry about the most. Right. That's why we're giving the neoadjuvant chemo.

And neoadjuvant chemo gets you 25% to 38%. There is that variability of did you get a good TUR? Was it in a location where you could have truly resected all of it? And those factors are really hard to account for. But I think to me, when I think about these things, I think that the distant metastatic potential is what I worry about the most. Right. That's why we're giving the neoadjuvant chemo.

And neoadjuvant chemo gets you 25% to 38%. There is that variability of did you get a good TUR? Was it in a location where you could have truly resected all of it? And those factors are really hard to account for. But I think to me, when I think about these things, I think that the distant metastatic potential is what I worry about the most. Right. That's why we're giving the neoadjuvant chemo.

It's for the micrometastatic disease. It's to combat that. And so here the adjuvant stuff becomes really important because. PT zero, I don't know how meaningful of an endpoint it is long term. Right.

It's for the micrometastatic disease. It's to combat that. And so here the adjuvant stuff becomes really important because. PT zero, I don't know how meaningful of an endpoint it is long term. Right.

It's for the micrometastatic disease. It's to combat that. And so here the adjuvant stuff becomes really important because. PT zero, I don't know how meaningful of an endpoint it is long term. Right.

And I think to that point, so there were in this trial, correct me if I'm wrong, about 60 something patients, 63 patients who ended up not getting a cystectomy. So figuring out the data on those patients, I think also will be informative. What do you think about that and how that factors into how we interpret the data altogether? Yeah.

And I think to that point, so there were in this trial, correct me if I'm wrong, about 60 something patients, 63 patients who ended up not getting a cystectomy. So figuring out the data on those patients, I think also will be informative. What do you think about that and how that factors into how we interpret the data altogether? Yeah.

And I think to that point, so there were in this trial, correct me if I'm wrong, about 60 something patients, 63 patients who ended up not getting a cystectomy. So figuring out the data on those patients, I think also will be informative. What do you think about that and how that factors into how we interpret the data altogether? Yeah.

If those patients remain disease-free, right? That's the important caveat because from retrospective data, we know that patients who were T0 after neoadjuvant therapy, who didn't go on to cystectomy, have a recurrence rate of up to 50%, right, if you follow them one to two years. And so obviously that's without adjuvant treatment.

If those patients remain disease-free, right? That's the important caveat because from retrospective data, we know that patients who were T0 after neoadjuvant therapy, who didn't go on to cystectomy, have a recurrence rate of up to 50%, right, if you follow them one to two years. And so obviously that's without adjuvant treatment.

If those patients remain disease-free, right? That's the important caveat because from retrospective data, we know that patients who were T0 after neoadjuvant therapy, who didn't go on to cystectomy, have a recurrence rate of up to 50%, right, if you follow them one to two years. And so obviously that's without adjuvant treatment.

But I think that's where a lot of the future will come in is how can we treat this patient? How can we pursue Protect the bladder, certainly. I mean, if we get to a point in bladder cancer that I don't have to take out bladders, I won't cry. But I want my patients to do well.

But I think that's where a lot of the future will come in is how can we treat this patient? How can we pursue Protect the bladder, certainly. I mean, if we get to a point in bladder cancer that I don't have to take out bladders, I won't cry. But I want my patients to do well.

But I think that's where a lot of the future will come in is how can we treat this patient? How can we pursue Protect the bladder, certainly. I mean, if we get to a point in bladder cancer that I don't have to take out bladders, I won't cry. But I want my patients to do well.

And I think figuring out which patients are going to be able to do well with their bladders intact and how do we get them there, that'll really change the game. I mean, certainly that's what we all want. That's what I would want.

And I think figuring out which patients are going to be able to do well with their bladders intact and how do we get them there, that'll really change the game. I mean, certainly that's what we all want. That's what I would want.

And I think figuring out which patients are going to be able to do well with their bladders intact and how do we get them there, that'll really change the game. I mean, certainly that's what we all want. That's what I would want.