{
  "abstract": "The approval of adjuvant nivolumab and pembrolizumab following radical cystectomy and more recently perioperative durvalumab-based strategies represents a significant therapeutic advance in muscle-invasive bladder cancer (MIBC). However, a question that has received limited systematic attention concerns the optimal timing of immunotherapy initiation after surgery. Current recommendations are derived entirely from the eligibility windows of pivotal clinical trials, most notably CheckMate 274, AMBASSADOR and NIAGARA, which mandated randomization within approximately 120 days of cystectomy. These operational thresholds were designed to ensure postoperative recovery and were not prospectively validated as biologically optimal. This review critically examines the biological rationale underpinning timing considerations, appraises what clinical trials have actually studied, draws cautious parallels with adjuvant chemotherapy literature, and discusses how circulating tumour DNA (ctDNA) and minimal residual disease (MRD) detection may eventually redefine timing decisions. We conclude that no validated therapeutic window currently exists, that available evidence supports initiation within the studied timeframe when clinically feasible, and that prospective timing analyzes constitute a major unmet need in MIBC research.",
  "abstract_shown": true,
  "affiliations": [
    "Hematology Oncology Department, Saint Joseph University of Beirut"
  ],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Nabih Naim"
    },
    {
      "affs": [
        0
      ],
      "name": "Ahmad Saad"
    },
    {
      "affs": [
        0
      ],
      "name": "Nesrine Mohamad"
    },
    {
      "affs": [
        0
      ],
      "name": "Joseph Kattan"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/a0sk0bdzx2264.bib",
  "cited_by": 0,
  "doi": "10.3389/fonc.2026.1933232",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13732464/",
  "id": "a0sk0bdzx2264",
  "issns": [
    "2234-943X"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fonc.2026.1933232/full",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Review"
    ],
    [
      "openalex",
      "2746|Bladder and Urothelial Cancer Treatments"
    ]
  ],
  "openalex": "W7223083393",
  "pdf_url": "https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2026.1933232/pdf",
  "pmcid": "PMC13732464",
  "pmid": "42985454",
  "published": "2026-10-21",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/a0sk0bdzx2264.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:13Z",
      "native_id": "10.3389/fonc.2026.1933232",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fonc.2026.1933232/full"
    },
    {
      "first_seen": "2026-11-08T12:22:26Z",
      "native_id": "PMC13732464",
      "source": "pmc",
      "url": "https://doi.org/10.3389/fonc.2026.1933232"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Bladder and Urothelial Cancer Treatments",
      "subfield": "surgery"
    }
  ],
  "title": "Optimal timing of adjuvant immunotherapy after radical cystectomy in muscle-invasive bladder cancer: from calendar-based to MRD-guided decision making",
  "title_text": "Optimal timing of adjuvant immunotherapy after radical cystectomy in muscle-invasive bladder cancer: from calendar-based to MRD-guided decision making",
  "type": "peer-reviewed",
  "updated_at": "2026-11-08T12:22:26Z",
  "url": "https://research.draconitic.com/paper/a0sk0bdzx2264",
  "venue": "Frontiers in Oncology",
  "versions": []
}