María Natalia Gandur Quiroga, MD, MSc, outlines the infrastructure and systems requirements that will determine how broadly the enfortumab vedotin-ejfv (Padcev)-pembrolizumab (Keytruda) approval as a perioperative regimen for adults with muscle-invasive bladder cancer who are candidates for cystectomy translates into practice change outside the United States. Regulatory pathways, reimbursement structures, drug availability, infusion capacity, and toxicity monitoring capabilities will all shape real-world access to these high-cost therapies across diverse health systems. She also emphasizes the importance of well-functioning multidisciplinary pathways: Patients need rapid staging, early medical oncology involvement, timely treatment initiation, and smooth transitions through cystectomy and postoperative therapy. Her framing is forward-looking—the science is unambiguously practice-changing, and the opportunity ahead is building the health system capacity to deliver it equitably and on time. Click here for more bladder cancer contentRead More
