French AFU Cancer Committee Guidelines - Update 2024-2026: Muscle-invasive bladder cancer (MIBC)

Mathieu Roumiguié; Gautier Marcq; Yann Neuzillet; Anne Sophie Bajeot; Yves Allory; Paul Sargos; Priscilla Leon; François Audenet; Evanguelos Xylinas; Benjamin Pradère; Doriane Prost; Thomas Seisen; Constance Thibault; Alexandra Masson-Lecomte; Morgan Rouprêt

doi:10.1016/j.fjurol.2024.102741

French AFU Cancer Committee Guidelines - Update 2024-2026: Muscle-invasive bladder cancer (MIBC)

Fr J Urol. 2024 Nov;34(12):102741. doi: 10.1016/j.fjurol.2024.102741.

Authors

Affiliations

¹ Urology Department, Toulouse University Hospital, University of Toulouse UT3, Toulouse, France. Electronic address: roumiguie.m@chu-toulouse.fr.
² Urology Department, Claude-Huriez Hospital, CHU de Lille, Université de Lille, CNRS, Inserm, Institut Pasteur de Lille, UMR9020-U1277, Cancer Heterogeneity Plasticity and Resistance to Therapies (CANTHER), 59000 Lille, France.
³ Urology Department, Hôpital Foch, Université Paris Saclay, Suresnes, France.
⁴ Urology Department, Toulouse University Hospital, University of Toulouse UT3, Toulouse, France.
⁵ Department of Pathology, Institut Curie, Université Paris Saclay, Saint-Cloud, France.
⁶ Radiotherapy Department, Institut Bergonié, Bordeaux, France.
⁷ Urology Department, Clinique Pasteur, Royan, France.
⁸ Department of Urology, Hôpital européen Georges-Pompidou, AP-HP Centre, Université Paris Cité, Paris, France.
⁹ Urology Department, Hôpital Bichat-Claude-Bernard, AP-HP, Université Paris Cité, Paris, France.
¹⁰ UROSUD Urology Department, Clinique Croix Du Sud, 31130 Quint-Fonsegrives, France.
¹¹ Urology Department, Paris Saint-Joseph Hospital, Sorbonne University, Paris, France.
¹² Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Hôpital Pitié-Salpetrière, 75013 Paris, France.
¹³ Medical Oncology Department, Hôpital européen Georges-Pompidou, AP-HP Centre, Université Paris Cité, Paris, France.
¹⁴ Department of Urology, Hôpital Saint-Louis, AP-HP, Université Paris Cité, Paris, France.

PMID: 39581664
DOI: 10.1016/j.fjurol.2024.102741

Abstract

Objective: To update the CCAFU recommendations for the management of muscle-invasive bladder cancer (MIBC).

Methods: A systematic review (Medline) of the literature from 2022 to 2024 was carried out, taking into account the elements of the diagnosis, the treatment options and the monitoring of NMIBC and MIBC, evaluating the references with their level of evidence.

Results: MIBC is diagosed after the must complete tumor resection possible . CT-Urography coupled with chest CT scans are used to assess the extent of MIBC. Multiparametric pelvic MRI may be an alternative imaging approach. Cystectomy combined with standard lymph node dissection is the standard treatment for nonmetastatic MIBC. Neoadjuvant cispaltine-based chemotherapy should be used in patients in good general health with satisfactory renal function. Enterocystoplasty is proposed for men and women in the absence of contraindications and when urethral recutting is negative on extemporaneous examination; otherwise, transileal cutaneous ureterostomy is the recommended method of urinary diversion. All patients should be included in an improved recovery after surgery (ERAS) protocol. For metastatic MIBC, first-line treatment with enfortumab vedotin and pembrolizumab is recommended. Second-line treatment with platinum-based chemotherapy is recommended.

Conclusion: Updating the ccAFU recommendations should improve patient management and enhance the diagnosis and treatment of MIBC.

Keywords: Bladder; Bladder tumours; Cancer; Cystectomy; Urothelial carcinoma.

Publication types

Practice Guideline
Systematic Review
Review

MeSH terms

Cystectomy
Humans
Neoplasm Invasiveness*
Urinary Bladder Neoplasms* / diagnosis
Urinary Bladder Neoplasms* / pathology
Urinary Bladder Neoplasms* / surgery
Urinary Bladder Neoplasms* / therapy