Muscle-Invasive Bladder Cancer Clinical Practice Guidelines (2019)

National Comprehensive Cancer Network

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

June 05, 2019

Guidelines on muscle-invasive bladder cancer were released in May 2019 by the National Comprehensive Cancer Network.[1]

Patients with stage II disease who are candidates for cystectomy should be distinguished from those who are not candidates for cystectomy.

A category 1 recommendation is to use neoadjuvant cisplatin-based therapy followed by radical or partial cystectomy in eligible patients.

Another category 1 recommendation is to use concurrent chemoradiotherapy for primary treatment of stage II disease in cystectomy candidates.

In patients who are not eligible for cystectomy, concurrent chemoradiotherapy or radiotherapy is the recommended primary treatment.

Stage IIIA now includes N1 (single regional lymph node in the true pelvis). Stage IIIB incorporates N2 and N3. Stage T4b disease is moved to a new group of stage IVA.

A new category of patients with locally advanced/metastatic bladder cancer is introduced and it is patients who are not eligible for platinum-based treatment who have no PD-L1 expression. Atezolizumab and pembrolizumab are the preferred first-line regimens; gemcitabine and gemcitabine/paclitaxel are other options. In patients who are not eligible for cisplatin but are eligible for carboplatin, use carboplatin over immune checkpoint inhibitors for first-line treatment.

For more information go to Bladder Cancer.

For more Clinical Practice Guidelines, go to Guidelines.

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