Guidelines

Muscle-invasive and Metastatic Bladder Cancer

Key changes in the 2018 print are:

  • Section 5.2 – Imaging for staging of MIBC. This section has been aligned with the EAU Guidelines on Urothelial Carcinoma of the Upper Urinary Tract (UTUC) [1].

 

5.2.6 Summary of evidence and guidelines for staging in muscle-invasive bladder cancer

Summary of evidence LE
The diagnosis of upper tract urothelial carcinoma depends on computed tomography urography and ureteroscopy.2

 

Recommendations Strength rating
Perform a computed tomography urography for upper tract evaluation and for staging.Strong
For upper tract evaluation, use diagnostic ureteroscopy and biopsy only in cases where additional information will impact treatment decisions.

Strong

 

 

  • Section 7.4.3.1 – Pelvic organ preservation techniques in men. The systematic review (SR) this section is based on has been published.

 

  • Section 7.4.3.2 – Pelvic organ preservation techniques in women. The SR this section is based on has been published [6].

 

  • Section 7.6.4 – Multimodality bladder-preserving treatment. This section was revised, to include new data, however, the recommendations did not change.

 

  • Section 7.8.10 – Role of immunotherapy. Two additional subsections have been added and new recommendations have been included.

 

7.8.11 Summary of evidence and guidelines for metastatic disease 

Summary of evidence LE
PD-1 inhibitor pembrolizumab has been approved for patients that have progressed during, or after, previous platinum-based chemotherapy based on the results of a phase-III trial.

1b

 

PD-1 inhibitor nivolumab has been approved for patients that have progressed during or after previous platinum-based chemotherapy based on the results of a phase-II trial.

2a

 

PD-1 inhibitor pembrolizumab has been approved for patients with advanced or metastatic urothelial cancer ineligible for cisplatin-based first-line chemotherapy based on the results of a phase-II trial.

2a

 

PD-L1 inhibitor atezolizumab has been approved for patients with advanced or metastatic urothelial cancer ineligible for cisplatin-based first-line chemotherapy based on the results of a phase-II trial.

2a

 

 

Recommendations Strength rating
First-line treatment in patients ineligible (unfit) for cisplatin:
Use checkpoint inhibitors pembrolizumab or atezolizumab.Strong
Use carboplatin combination chemotherapy.Weak
Second-line treatment
Offer checkpoint inhibitors pembrolizumab or atezolizumab to patients progressing during, or after, platinum-based combination chemotherapy for metastatic disease. Alternatively, offer treatment within a clinical trial setting.

Strong

 

Offer checkpoint inhibitor nivolumab to patients progressing during or after platinum-based combination chemotherapy for metastatic disease. Alternatively, offer treatment within a clinical trial setting.

Strong

 

Subsequent treatment
Only offer vinflunine to patients for metastatic disease as second-line treatment if immunotherapy or combination chemotherapy is not feasible. Alternatively, offer vinflunine as subsequent treatment line, or offer treatment within a clinical trial setting or best supportive care.

Weak

 

 

  • Figure 7.2 - Flow chart for the management of metastatic urothelial cancer was completely revised.

 

  • Chapter 8 – Follow-up has been completely revised.