Key changes in the 2018 print are:
- Section 5.2 – Imaging for staging of MIBC. This section has been aligned with the EAU Guidelines on Urothelial Carcinoma of the Upper Urinary Tract (UTUC) [1].
5.2.6 Summary of evidence and guidelines for staging in muscle-invasive bladder cancer
| Summary of evidence | LE |
| The diagnosis of upper tract urothelial carcinoma depends on computed tomography urography and ureteroscopy. | 2 |
| Recommendations | Strength rating |
| Perform a computed tomography urography for upper tract evaluation and for staging. | Strong |
| For upper tract evaluation, use diagnostic ureteroscopy and biopsy only in cases where additional information will impact treatment decisions. | Strong
|
- Section 7.4.3.1 – Pelvic organ preservation techniques in men. The systematic review (SR) this section is based on has been published.
- Section 7.4.3.2 – Pelvic organ preservation techniques in women. The SR this section is based on has been published [6].
- Section 7.6.4 – Multimodality bladder-preserving treatment. This section was revised, to include new data, however, the recommendations did not change.
- Section 7.8.10 – Role of immunotherapy. Two additional subsections have been added and new recommendations have been included.
7.8.11 Summary of evidence and guidelines for metastatic disease
| Summary of evidence | LE |
| PD-1 inhibitor pembrolizumab has been approved for patients that have progressed during, or after, previous platinum-based chemotherapy based on the results of a phase-III trial. | 1b
|
| PD-1 inhibitor nivolumab has been approved for patients that have progressed during or after previous platinum-based chemotherapy based on the results of a phase-II trial. | 2a
|
| PD-1 inhibitor pembrolizumab has been approved for patients with advanced or metastatic urothelial cancer ineligible for cisplatin-based first-line chemotherapy based on the results of a phase-II trial. | 2a
|
| PD-L1 inhibitor atezolizumab has been approved for patients with advanced or metastatic urothelial cancer ineligible for cisplatin-based first-line chemotherapy based on the results of a phase-II trial. | 2a
|
| Recommendations | Strength rating |
| First-line treatment in patients ineligible (unfit) for cisplatin: | |
| Use checkpoint inhibitors pembrolizumab or atezolizumab. | Strong |
| Use carboplatin combination chemotherapy. | Weak |
| Second-line treatment | |
| Offer checkpoint inhibitors pembrolizumab or atezolizumab to patients progressing during, or after, platinum-based combination chemotherapy for metastatic disease. Alternatively, offer treatment within a clinical trial setting. | Strong
|
| Offer checkpoint inhibitor nivolumab to patients progressing during or after platinum-based combination chemotherapy for metastatic disease. Alternatively, offer treatment within a clinical trial setting. | Strong
|
| Subsequent treatment | |
| Only offer vinflunine to patients for metastatic disease as second-line treatment if immunotherapy or combination chemotherapy is not feasible. Alternatively, offer vinflunine as subsequent treatment line, or offer treatment within a clinical trial setting or best supportive care. | Weak
|
- Figure 7.2 - Flow chart for the management of metastatic urothelial cancer was completely revised.
- Chapter 8 – Follow-up has been completely revised.