Muscle-invasive and Metastatic Bladder Cancer

Full Text Guidelines Summary of Changes Scientific Publications & Appendices Pocket Guidelines Archive Panel

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J.A. Witjes (Chair), E. Compérat, N.C. Cowan, G. Gakis, V. Hernández, T. Lebret, A. Lorch, A.G. van der Heijden, M.J. Ribal
Guidelines Associates: M. Bruins, E. Linares Espinós, M. Rouanne, Y. Neuzillet, E. Veskimäe

1.INTRODUCTION

1.1.Aims and scope

The European Association of Urology (EAU) Guidelines Panel for Muscle-invasive and Metastatic Bladder Cancer (MIBC) have prepared these guidelines to help urologists assess the evidence-based management of MIBC and to incorporate guideline recommendations into their clinical practice.

Separate EAU guidelines documents are available addressing upper urinary tract tumours [1], non-muscle-invasive bladder cancer (TaT1 and carcinoma in situ) [2], and primary urethral carcinomas [3].

It must be emphasised that clinical guidelines present the best evidence available to the experts but following guideline recommendations will not necessarily result in the best outcome. Guidelines can never replace clinical expertise when making treatment decisions for individual patients, but rather help to focus decisions - also taking personal values and preferences/individual circumstances of patients into account. Guidelines are not mandates and do not purport to be a legal standard of care.

1.2.Panel Composition

The EAU Guidelines Panel consists of an international multidisciplinary group of clinicians, including urologists, a pathologist, a radiologist and an oncologist.

All experts involved in the production of this document have submitted potential conflict of interest statements which can be viewed on the EAU website Uroweb: http://uroweb.org/guideline/bladder-cancermuscle-invasive-and-metastatic/?type=panel.

1.3.Available publications

A quick reference document (Pocket Guidelines) is available, both in print and in a number of versions for mobile devices. These are abridged versions which may require consultation together with the full text version.

Several scientific publications are available (the most recent paper dating back to 2016 [4]), as are a number of translations of all versions of the EAU MIBC Guidelines. All documents are accessible through the EAU website: http://uroweb.org/guideline/bladder-cancer-muscle-invasive-and-metastatic/.

1.4.Publication history and summary of changes

1.4.1.Publication history

The EAU published its first guidelines on bladder cancer in 2000. This document covered both superficial (non-muscle-invasive) bladder cancer and MIBC. Since these conditions require different treatment strategies, it was decided to give each condition its own guidelines, resulting in the first publication of the MIBC Guidelines in 2004. This 2017 document presents a limited update of the 2016 version.

1.4.2.Summary of changes

New relevant references have been identified through a structured assessment of the literature and incorporated in the various chapters of the 2017 EAU NMIBC Guidelines.

Key changes in the 2017 print are:

Section 3.2.6 Gender - This section has been expanded with additional data.

Section 5.1.4 Urinary cytology and urinary markers - This section has been expanded with additional data.

Section 6.2.4 Prognostic markers - A new section has been included.

Section 7.4.4.1 Preparations for surgery - A new section on pain management has been included as well as additional data on estimated glomerular filtration rate.

Section 7.4.4.2.1 Ureterocutaneostomy - This section has been expanded with additional data.

Table 7.6 Management of neobladder morbidity - Additional information has been added.

Section 7.8.10 Role of immunotherapy - This is a new section.

1.4.2.1.Change in summary of evidence

7.8.11 Summary of evidence and recommendations for metastatic disease

7.8.11 Summary of evidence for metastatic disease

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PD-L1 inhibitor atezolizumab has been FDA approved for patients that have progressed during or after previous platinum-based chemotherapy based on the results of a phase-II trial.

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