Optimal Management of Muscle-invasive Bladder Cancer: Recommendations from the International Bladder Cancer Group

Area of Science:

• Urology
• Oncology
• Cancer Research

Background:

• Management of muscle-invasive bladder cancer (MIBC) is rapidly evolving.
• New perioperative treatments and bladder preservation strategies are emerging.
• Clinical staging and therapeutic sequencing require updated guidance.

Purpose of the Study:

• To provide evidence-based recommendations for MIBC management in clinical practice.
• To guide the design of future clinical trials for MIBC.
• To establish consensus among global experts on optimal treatment strategies.

Main Methods:

• Convened global experts in bladder cancer (International Bladder Cancer Group - IBCG).
• Reviewed existing literature and developed draft recommendations.
• Utilized a modified Delphi process with voting during a live meeting (August 2024).

Main Results:

• Recommended thorough clinical staging and multidisciplinary care for MIBC.
• Radical cystectomy (RC) and trimodal therapy show similar oncologic efficacy.
• Upfront RC for squamous-cell carcinoma/adenocarcinoma; neoadjuvant cisplatin therapy before RC for other subtypes.
• Risk-stratified adjuvant therapy post-RC recommended.
• No validated biomarkers for treatment selection outside trials.
• Recommended time-to-event endpoints for perioperative trials and bladder-intact event-free survival for bladder preservation trials, including quality-of-life outcomes.

Conclusions:

• IBCG consensus provides practical guidance on optimal treatment sequencing for MIBC.
• Emphasizes the importance of multidisciplinary care and risk-stratified approaches.
• Highlights the need for specific endpoints in clinical trial design for MIBC therapies.