Combining surgery or radiation with new treatments chosen carefully for each patient can improve outcomes in muscle-invasive bladder cancer, according to a consensus statement from the International Bladder Cancer Group published in the journal European Urology.
Treatment for advanced bladder cancer has changed quickly in recent years. New types of medicines, like checkpoint inhibitors (drugs that help the immune system fight cancer) and antibody-drug conjugates (special treatment combinations) are now being used. But doctors are still working to figure out the best order to give these treatments in muscle-invasive bladder cancer and the best ways to measure how well they work.
The International Bladder Cancer Group brought together experts from around the world to create a set of recommendations. They reviewed research, made draft suggestions and then voted on them at a meeting in August 2024.
The expert group says patients with muscle-invasive bladder cancer should get careful testing to see how far the cancer has spread. They should also be treated by a team of different specialists.
Studies show that removing the bladder (called radical cystectomy) and a three-part treatment plan (called trimodal therapy) work about the same in controlling cancer.
Patients with certain rare types of bladder cancer, pure squamous-cell carcinoma or adenocarcinoma, should usually have surgery first. Most other patients should get chemotherapy before surgery.
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After surgery, more treatment may be given based on the patient’s risk. Right now, there are no proven lab tests that can help doctors choose the best treatment for these patients outside of research studies.
The group also says that clinical trials should measure how long patients live without the cancer getting worse. For patients trying to keep their bladder, studies should measure how long they stay cancer-free without needing bladder removal.
“Decisions are best made by a multidisciplinary team and should also consider quality of life and patient preferences,” the experts said.
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