EAU-ESMO consensus statements on the management of advanced and variant bladder cancer-an international collaborative multi-stakeholder effort: under the auspices of the EAU and ESMO Guidelines Committees

Publication

EAU-ESMO consensus statements on the management of advanced and variant bladder cancer-an international collaborative multi-stakeholder effort: under the auspices of the EAU and ESMO Guidelines Committees

Journal Paper/Review - Jan 8, 2020

Khoo V, N'Dow J, Necchi A, Neuzillet Y, Oddens J R, Oldenburg J, Osanto S, Oyen W J G, Pacheco-Figueiredo L, Pappot H, Patel M I, Pieters B R, Plass K, Remzi M, Müller C R, Müller A-C, Kiltie A E, Krege S, Ladoire S, Lara P C, Leliveld A, Linares-Espinós E, Løgager V, Lorch A, Loriot Y, Meijer R, Carmen Mir M, Moschini M, Mostafid H, Retz M, Richenberg J, Turkbey B, Vahr Lauridsen S, Valdagni R, Van Der Heijden A G, Van Poppel H, Vartolomei M D, Veskimäe E, Vilaseca A, Vives Rivera F A, Wiegel T, Wiklund P, Williams A, Zigeuner R, Tombal B, Thalmann G N, Rink M, Roghmann F, Rosenberg J E, Rouprêt M, Rouvière O, Salembier C, Salminen A, Sargos P, Sengupta S, Sherif A, Smeenk R J, Smits A, Stenzl A, Witjes J A, Kamat A M, Horwich A, Arends T, Bamias A, Birtle A, Black P C, Bochner B H, Bolla M, Boormans J L, Bossi A, Briganti A, Brummelhuis I, Burger M, Castellano D, Cathomas R, Agarwal N, Xylinas E, Babjuk M, Bellmunt J, Bruins H M, De Reijke T M, De Santis M, Gillessen Sommer Silke, James N, Maclennan S, Palou J, Powles T, Ribal M J, Shariat S F, van der Kwast T, Chiti A, Choudhury A, Gontero P, Grubmüller B, Hafeez S, Hansel D E, Hartmann A, Hayne D, Henry A M, Hernandez V, Herr H, Herrmann K, Hoskin P, Huguet J, Jereczek-Fossa B A, Geavlete B, Gakis G, Compérat E, Crabb S, Culine S, De Bari B, DeBlok W, De Visschere P J L, Decaestecker K, Dimitropoulos K, Dominguez-Escrig J L, Fanti S, Fonteyne V, Frydenberg M, Futterer J J, Jones R

Citation

Khoo V, N'Dow J, Necchi A, Neuzillet Y, Oddens J, Oldenburg J, Osanto S, Oyen W, Pacheco-Figueiredo L, Pappot H, Patel M, Pieters B, Plass K, Remzi M, Müller C, Müller A, Kiltie A, Krege S, Ladoire S, Lara P, Leliveld A, Linares-Espinós E, Løgager V, Lorch A, Loriot Y, Meijer R, Carmen Mir M, Moschini M, Mostafid H, Retz M, Richenberg J, Turkbey B, Vahr Lauridsen S, Valdagni R, Van Der Heijden A, Van Poppel H, Vartolomei M, Veskimäe E, Vilaseca A, Vives Rivera F, Wiegel T, Wiklund P, Williams A, Zigeuner R, Tombal B, Thalmann G, Rink M, Roghmann F, Rosenberg J, Rouprêt M, Rouvière O, Salembier C, Salminen A, Sargos P, Sengupta S, Sherif A, Smeenk R, Smits A, Stenzl A, Witjes J, Kamat A, Horwich A, Arends T, Bamias A, Birtle A, Black P, Bochner B, Bolla M, Boormans J, Bossi A, Briganti A, Brummelhuis I, Burger M, Castellano D, Cathomas R, Agarwal N, Xylinas E, Babjuk M, Bellmunt J, Bruins H, De Reijke T, De Santis M, Gillessen Sommer S, James N, Maclennan S, Palou J, Powles T, Ribal M, Shariat S, van der Kwast T, Chiti A, Choudhury A, Gontero P, Grubmüller B, Hafeez S, Hansel D, Hartmann A, Hayne D, Henry A, Hernandez V, Herr H, Herrmann K, Hoskin P, Huguet J, Jereczek-Fossa B, Geavlete B, Gakis G, Compérat E, Crabb S, Culine S, De Bari B, DeBlok W, De Visschere P, Decaestecker K, Dimitropoulos K, Dominguez-Escrig J, Fanti S, Fonteyne V, Frydenberg M, Futterer J, Jones R. EAU-ESMO consensus statements on the management of advanced and variant bladder cancer-an international collaborative multi-stakeholder effort: under the auspices of the EAU and ESMO Guidelines Committees. Ann Oncol 2020; 30:1697-1727.

Type

Journal Paper/Review (English)

Journal

Ann Oncol 2020; 30

Publication Date

Jan 8, 2020

Issn Electronic

1569-8041

Pages

1697-1727

Brief description/objective

BACKGROUND
Although guidelines exist for advanced and variant bladder cancer management, evidence is limited/conflicting in some areas and the optimal approach remains controversial.

OBJECTIVE
To bring together a large multidisciplinary group of experts to develop consensus statements on controversial topics in bladder cancer management.

DESIGN
A steering committee compiled proposed statements regarding advanced and variant bladder cancer management which were assessed by 113 experts in a Delphi survey. Statements not reaching consensus were reviewed; those prioritised were revised by a panel of 45 experts before voting during a consensus conference.

SETTING
Online Delphi survey and consensus conference.

PARTICIPANTS
The European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), experts in bladder cancer management.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Statements were ranked by experts according to their level of agreement: 1-3 (disagree), 4-6 (equivocal), 7-9 (agree). A priori (level 1) consensus was defined as ≥70% agreement and ≤15% disagreement, or vice versa. In the Delphi survey, a second analysis was restricted to stakeholder group(s) considered to have adequate expertise relating to each statement (to achieve level 2 consensus).

RESULTS AND LIMITATIONS
Overall, 116 statements were included in the Delphi survey. Of these, 33 (28%) statements achieved level 1 consensus and 49 (42%) statements achieved level 1 or 2 consensus. At the consensus conference, 22 of 27 (81%) statements achieved consensus. These consensus statements provide further guidance across a broad range of topics, including the management of variant histologies, the role/limitations of prognostic biomarkers in clinical decision making, bladder preservation strategies, modern radiotherapy techniques, the management of oligometastatic disease and the evolving role of checkpoint inhibitor therapy in metastatic disease.

CONCLUSIONS
These consensus statements provide further guidance on controversial topics in advanced and variant bladder cancer management until a time where further evidence is available to guide our approach.