EAU-ESMO Consensus Statements on the Management of Advanced and Variant Bladder Cancer-An International Collaborative Multistakeholder Effort: Under the Auspices of the EAU-ESMO Guidelines Committees

Publication

EAU-ESMO Consensus Statements on the Management of Advanced and Variant Bladder Cancer-An International Collaborative Multistakeholder Effort: Under the Auspices of the EAU-ESMO Guidelines Committees

Journal Paper/Review - Nov 19, 2019

Khoo Vincent, N'Dow James, Necchi Andrea, Neuzillet Yann, Oddens Jorg R, Oldenburg Jan, Osanto Susanne, J G Oyen Wim, Pacheco-Figueiredo Luís, Pappot Helle, Patel Manish I, Pieters Bradley R, Plass Karin, Remzi Mesut, Müller Christoph R, Müller Arndt-Christian, Kiltie Anne E, Krege Susanne, Ladoire Sylvain, Lara Pedro C, Leliveld Annemarie, Linares-Espinós Estefania, Løgager Vibeke, Lorch Anja, Loriot Yohann, Meijer Richard, Mir M Carmen, Moschini Marco, Mostafid Hugh, Retz Margitta, Richenberg Jonathan, Turkbey Baris, Lauridsen Susanne Vahr, Valdagni Riccardo, Der Heijden Antoine G Van, Van Poppel Hein, Vartolomei Mihai D, Veskimäe Erik, Vilaseca Antoni, Rivera Franklin A Vives, Wiegel Thomas, Wiklund Peter, Williams Andrew, Zigeuner Richard, Tombal Bertrand, Thalmann George N, Rink Michael, Roghmann Florian, Rosenberg Jonathan E, Rouprêt Morgan, Rouvière Olivier, Salembier Carl, Salminen Antti, Sargos Paul, Sengupta Shomik, Sherif Amir, Smeenk Robert J, Smits Anita, Stenzl Arnulf, Horwich Alan, Kamat Ashish M, Witjes J Alfred, Arends Tom, Bamias Aristotle, Birtle Alison, Black Peter C, Bochner Bernard H, Bolla Michel, Boormans Joost L, Bossi Alberto, Briganti Alberto, Brummelhuis Iris, Burger Max, Castellano Daniel, Cathomas Richard, Agarwal Neeraj, Xylinas Evanguelos, Babjuk Marek, Bellmunt Joaquim, Bruins H Maxim, de Reijke Theo M, De Santis Maria, Gillessen Sommer Silke, James Nicholas, MacLennan Steven, Palou Juan, Powles Tom, Ribal Maria J, Shariat Shahrokh F, Der Kwast Theo Van, Chiti Arturo, Choudhury Ananya, Gontero Paolo, Grubmüller Bernhard, Hafeez Shaista, Hansel Donna E, Hartmann Arndt, Hayne Dickon, Henry Ann M, Hernandez Virginia, Herr Harry, Herrmann Ken, Hoskin Peter, Huguet Jorge, Jereczek-Fossa Barbara A, Geavlete Bogdan, Gakis Georgios, Compérat Eva, Crabb Simon, Culine Stéphane, De Bari Berardino, De Blok Willem, J L De Visschere Pieter, Decaestecker Karel, Dimitropoulos Konstantinos, Dominguez-Escrig Jose L, Fanti Stefano, Fonteyne Valerie, Frydenberg Mark, Futterer Jurgen J, Jones Rob

Citation

Khoo V, N'Dow J, Necchi A, Neuzillet Y, Oddens J, Oldenburg J, Osanto S, J G 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, Mir M, Moschini M, Mostafid H, Retz M, Richenberg J, Turkbey B, Lauridsen S, Valdagni R, Der Heijden A, Van Poppel H, Vartolomei M, Veskimäe E, Vilaseca A, 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, Horwich A, Kamat A, Witjes J, 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, 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, De Blok W, J L 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 Multistakeholder Effort: Under the Auspices of the EAU-ESMO Guidelines Committees. Eur Urol 2019; 77:223-250.

Type

Journal Paper/Review (English)

Journal

Eur Urol 2019; 77

Publication Date

Nov 19, 2019

Issn Electronic

1873-7560

Pages

223-250

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 prior to 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), and 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 statements, 33 (28%) achieved level 1 consensus and 49 (42%) 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 when further evidence is available to guide our approach.

PATIENT SUMMARY
This report summarises findings from an international, multistakeholder project organised by the EAU and ESMO. In this project, a steering committee identified areas of bladder cancer management where there is currently no good-quality evidence to guide treatment decisions. From this, they developed a series of proposed statements, 71 of which achieved consensus by a large group of experts in the field of bladder cancer. It is anticipated that these statements will provide further guidance to health care professionals and could help improve patient outcomes until a time when good-quality evidence is available.