Updated MIBC Treatment Guidelines From AUA, ASCO, SUO

The American Urological Association (AUA), American Society of Clinical Oncology (ASCO), and Society of Urologic Oncology (SUO) recently released updated guidelines on the treatment of muscle invasive bladder cancer (MIBC).

The guidelines were published in The Journal of Urology.

The new recommendations included changes to neoadjuvant and adjuvant chemotherapy, radical cystectomy, pelvic lymphadenectomy, and multimodal bladder-preserving therapy. The associations also updated guidelines regarding the methodology and reference sections.

Clinicians were advised that prior to radical cystectomy, patients should be offered cisplatin-based neoadjuvant chemotherapy (NAC). Upon cystectomy, those with pT3-4 and/or N+ disease who have not undergone treatment with cisplatin-based NAC should be recommended to receive adjuvant cisplatin-based chemotherapy or adjuvant immunotherapy. Adjuvant immunotherapy should be offered to patients who have pT2-4 and/or N+ disease and have received cisplatin-based chemotherapy.

When conducting a standard radical cystectomy with curative intent on males, the bladder, prostate, and seminal vesicles should be removed. In females, the bladder should be removed, and clinicians should contemplate removing the adjacent reproductive organs depending on disease characteristics and the necessity to obtain negative margins.

The external and internal iliac, as well as the obturator lymph nodes, should be removed during a bilateral pelvic lymphadenectomy.

Clinicians should recommend maximal transurethral resection of bladder tumor followed by chemotherapy plus external beam radiation therapy for patients who are set to receive trimodality therapy plus organ preservation. They should also perform planned cystoscopic surveillance in accordance with the high-risk non-muscle invasive bladder cancer schedule.

Regular surveillance plus computed tomography scans, cystoscopy, and urine cytology should be conducted after the completion of bladder-preserving therapy.

“This guideline seeks to improve clinicians’ ability to evaluate and treat patients with MIBC based on currently available evidence,” the organizations wrote. “Future studies will be essential to further support or refine these statements to improve patient care.”