The management of muscle-invasive bladder cancer (MIBC) is evolving rapidly with the emergence of new perioperative treatments and approaches for bladder preservation. We provide guidance on clinical staging and optimal therapeutic sequencing for patients with MIBC in clinical practice and within the context of clinical trial design.
The International Bladder Cancer Group (IBCG) convened global experts in bladder cancer to develop recommendations for the management of MIBC and to guide clinical trial design. Working groups reviewed the literature and developed draft recommendations. This was followed by voting by the IBCG members during a live meeting in August 2024 using a modified Delphi process. Recommendations achieving ≥75% agreement during the meeting were further refined and presented.
The IBCG recommends thorough clinical staging and multidisciplinary care for patients with MIBC. Contemporary retrospective comparisons suggest that radical cystectomy (RC) and trimodal therapy have similar oncologic efficacy. Patients with pure squamous-cell carcinoma or adenocarcinoma are best managed with upfront RC, while cisplatin-based neoadjuvant therapy before RC is recommended for other histologic subtypes. Risk-stratified adjuvant therapy approaches should be used after RC. There are no currently validated predictive biomarkers to guide clinical decision-making in MIBC outside the context of a clinical trial. The IBCG recommends the use of time-to-event endpoints for perioperative therapy trials, and bladder-intact event-free survival for bladder preservation trials, with an emphasis on incorporating patient-reported quality-of-life endpoints.
The IBCG consensus recommendations provide practical guidance on optimal treatment sequencing strategies in the management of MIBC.
European urology. 2026 Feb 21 [Epub ahead of print]
Shilpa Gupta, Roger Li, Patrick J Hensley, Siamak Daneshmand, Bishoy M Faltas, Petros Grivas, Niyati Lobo, Maria Carmen Mir, Joshua J Meeks, Kent W Mouw, Marco Moschini, Andrea Necchi, Karima Oualla, Kamal S Pohar, Jonathan E Rosenberg, Bogdana Schmidt, Arlene O Siefker-Radtke, Gary D Steinberg, Arnulf Stenzl, Roger J Buckley, Ashish M Kamat
Department of Genitourinary Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA., Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA., Department of Urology, University of Kentucky, Lexington, KY, USA., Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA., Division of Hematology and Medical Oncology, Weill-Cornell Medicine, New York, NY, USA., Fred Hutchinson Cancer Center, Department of Medicine, University of Washington, Seattle, WA, USA., Department of Urology, Cambridge University Hospitals, Cambridge, UK., Department of Urology, Hospital Universitario La Ribera, Valencia, Spain., Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA., Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA., Department of Urology, San Raffaele Hospital and Scientific Institute, Milan, Italy., Department of Oncology, Vita-Salute San Raffaele University, Milan, Italy., Department of Medical Oncology, Hassan II University Hospital, Fes, Morocco., Department of Urology, Ohio State University, Columbus, OH, USA., Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Department of Surgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA., Department of Genitourinary Medical Oncology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA., Department of Urology, Rush University Medical Center, Chicago, IL, USA., Department of Urology, Eberhard-Karls University, Tübingen, Germany., Department of Urology, North York General Hospital, Toronto, Canada., Department of Urology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA. Electronic address: .