For the 2025 MIBC Guidelines new and relevant evidence was identified, collated and appraised through a structured assessment of the literature for all sections of the Guidelines. Key changes include:
- New summary of evidence and recommendation in section 6.5 for use of susceptible FGFR3 alterations to select patients with unresectable or metastatic urothelial carcinoma for treatment with erdafitinib.
- Significant adaption and update to the recommendations for pre- and post-operative radiotherapy in section 7.2.3.
- Significant adaption and update to the summary of evidence and recommendation in section 7.3.3.2.1 sexual-preserving techniques in women.
- New recommendation in section 7.3.10 related radical cystectomy and urinary diversion based on the results of the SWOG trial. In addition, the recommendation related to hospital volume in this section has been adapted.
- New recommendation in section 7.4.1 for salvage cystectomy after trimodality therapy.
- New recommendation in section 7.5.4.1. for manage all patients who are candidates for trimodality bladder-preserving treatment in a multidisciplinary team setting using a shared-decision making process.
- Significant adaption and update to the recommendation for adjuvant nivolumab in selected patients with pT3/4 and/or pN+ disease not eligible for, or who declined, adjuvant cisplatin-based chemotherapy in section 7.6.3. Upgraded strength rating.
- Updated of the summary of evidence in section 7.7.9 and addition of a new recommendation for metastatic disease in this section regarding antibody drug conjugate Trastuzumab deruxtecan in case of Her2 over expression. In addition the recommendations on Sacituzumab govitecan have been removed as the manufacturer has withdrawn FDA approval for this product.
- Update of section 8.1 follow-up for MIBC.
- Update of figures 7.1 and 7.2.