Shalini Moningi, MD

Identifying Safer, Less Intensive Treatment Options for Muscle-Invasive Bladder Cancer

For patients with muscle‑invasive bladder cancer (MIBC), the usual treatments are chemotherapy before surgery to remove the bladder or a combination of chemotherapy and radiation. While these approaches can be effective, they also come with serious side effects that can greatly affect a patient’s quality of life.

Recent studies have shown that up to one‑third of patients have a complete response to chemotherapy before surgery, meaning doctors can no longer detect cancer in the bladder. These patients might be able to safely avoid bladder removal or full‑dose radiation, but current medical tools are not reliable enough to confidently identify who can skip these aggressive treatments. Because of this uncertainty, most patients still undergo major surgery or full‑strength radiation even when they may not need it.

Early research, including recent clinical trials, suggests that some carefully selected patients may do just as well with active surveillance — close monitoring instead of immediate surgery — after responding completely to chemotherapy. However, a large, forward‑looking study is still needed to prove that this less‑intensive approach is as safe as the current standard of care.

Dr. Moningi’s goal is to provide that evidence. She and her team will evaluate whether patients with MIBC who show a complete clinical response after chemotherapy or immunotherapy, based on blood tests, bladder MRI and repeat tumor sampling, can safely receive a lower dose of radiation and then be monitored. The intent is to determine whether treatment can be safely reduced for certain patients, helping them avoid unnecessary side effects while still effectively controlling the cancer.