The American Society of Clinical Oncology (ASCO) endorsed the European Association of Urology’s guideline on muscle-invasive bladder cancer (MIBC) and metastatic bladder cancer and has added qualifying statements, according to a statement published in the Journal of Clinical Oncology.1

Researchers from the ASCO Endorsement Panel led by Matthew Milowsky, MD, of the University of North Carolina Lineberger Comprehensive Cancer Center in Chapel Hill reviewed the guideline on MIBC and metastatic bladder cancer that was published online in March 2015 for developmental rigor.

They determined that the guideline was “clear, thorough, and based on the most relevant scientific evidence.”

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In addition to its endorsement, the ASCO panel added qualifying statements that included highlighting the use of chemoradiotherapy for select patients with MIBC as well as recommending a preference for clinical trials in the treatment of metastatic disease in the second-line setting.

“The standard treatment of MIBC is neoadjuvant cisplatin-based combination chemotherapy followed by radical cystectomy,” the authors concluded. They recommended radical cystectomy alone in cisplatin-ineligible patients, and adjuvant cisplatin-based chemotherapy to high-risk patients who have not received neoadjuvant therapy.

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Finally, chemoradiotherapy should be offered as an alternative to cystectomy in appropriately selected patients with MIBC and in some patients for whom cystectomy may not be an option. Metastatic disease should be treated with cisplatin-containing combination chemotherapy, carboplatin combination chemotherapy, or single agents among patients ineligible for cisplatin.


  1. Milowsky MI, Rumble RB, Booth CM, et al. Guideline on muscle-invasive and metastatic bladder cancer (European Association of Urology guideline): American Society of Clinical Oncology clinical practice guideline endorsement [published online ahead of print March 21, 2016]. J Clin Oncol. doi: 10.1200/JCO.2015.65.9797.