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

TY - JOUR

T1 - 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

AU - Witjes, J Alfred

AU - Babjuk, Marek

AU - Bellmunt, Joaquim

AU - Bruins, H Maxim

AU - De Reijke, Theo M

AU - De Santis, Maria

AU - Gillessen, Silke

AU - James, Nicholas

AU - Maclennan, Steven

AU - Palou, Juan

AU - Powles, Tom

AU - Ribal, Maria J

AU - Shariat, Shahrokh F

AU - Der Kwast, Theo Van

AU - Xylinas, Evanguelos

AU - Agarwal, Neeraj

AU - Arends, Tom

AU - Bamias, Aristotle

AU - Birtle, Alison

AU - Black, Peter C

AU - Bochner, Bernard H

AU - Bolla, Michel

AU - Boormans, Joost L

AU - Bossi, Alberto

AU - Briganti, Alberto

AU - Brummelhuis, Iris

AU - Burger, Max

AU - Castellano, Daniel

AU - Cathomas, Richard

AU - Chiti, Arturo

AU - Choudhury, Ananya

AU - Compérat, Eva

AU - Crabb, Simon

AU - Culine, Stephane

AU - De Bari, Berardino

AU - De Blok, Willem

AU - J L De Visschere, Pieter

AU - Decaestecker, Karel

AU - Dimitropoulos, Konstantinos

AU - Dominguez-Escrig, Jose L

AU - Fanti, Stefano

AU - Fonteyne, Valerie

AU - Frydenberg, Mark

AU - Futterer, Jurgen J

AU - Gakis, Georgios

AU - Geavlete, Bogdan

AU - Gontero, Paolo

AU - Grubmüller, Bernhard

AU - Hafeez, Shaista

AU - Hansel, Donna E

AU - Hartmann, Arndt

AU - Hayne, Dickon

AU - Henry, Ann M

AU - Hernandez, Virginia

AU - Herr, Harry

AU - Herrmann, Ken

AU - Hoskin, Peter

AU - Huguet, Jorge

AU - Jereczek-Fossa, Barbara A

AU - Jones, Rob

AU - Kamat, Ashish M

AU - Khoo, Vincent

AU - Kiltie, Anne E

AU - Krege, Susanne

AU - Ladoire, Sylvain

AU - Lara, Pedro C

AU - Leliveld, Annemarie

AU - Linares-Espinós, Estefania

AU - Løgager, Vibeke

AU - Lorch, Anja

AU - Loriot, Yohann

AU - Meijer, Richard

AU - Mir, M Carmen

AU - Moschini, Marco

AU - Mostafid, Hugh

AU - Müller, Arndt-Christian

AU - Müller, Christoph R

AU - N'Dow, James

AU - Necchi, Andrea

AU - Neuzillet, Yann

AU - Oddens, Jorg R

AU - Oldenburg, Jan

AU - Osanto, Susanne

AU - J G Oyen, Wim

AU - Pacheco-Figueiredo, Luís

AU - Pappot, Helle

AU - Patel, Manish I

AU - Pieters, Bradley R

AU - Plass, Karin

AU - Remzi, Mesut

AU - Retz, Margitta

AU - Richenberg, Jonathan

AU - Rink, Michael

AU - Roghmann, Florian

AU - Rosenberg, Jonathan E

AU - Rouprêt, Morgan

AU - Rouvière, Olivier

AU - Salembier, Carl

AU - Salminen, Antti

AU - Sargos, Paul

AU - Sengupta, Shomik

AU - Sherif, Amir

AU - Smeenk, Robert J

AU - Smits, Anita

AU - Stenzl, Arnulf

AU - Thalmann, George N

AU - Tombal, Bertrand

AU - Turkbey, Baris

AU - Lauridsen, Susanne Vahr

AU - Valdagni, Riccardo

AU - Van Der Heijden, Antoine G

AU - Van Poppel, Hein

AU - Vartolomei, Mihai D

AU - Veskimäe, Erik

AU - Vilaseca, Antoni

AU - Rivera, Franklin A Vives

AU - Wiegel, Thomas

AU - Wiklund, Peter

AU - Williams, Andrew

AU - Zigeuner, Richard

AU - Horwich, Alan

N1 - Copyright © 2019 European Society of Medical Oncology and European Association of Urology. Published by Elsevier B.V. All rights reserved.

PY - 2020/2

Y1 - 2020/2

N2 - 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.

AB - 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.

U2 - 10.1016/j.eururo.2019.09.035

DO - 10.1016/j.eururo.2019.09.035

M3 - SCORING: Journal article

C2 - 31753752

VL - 77

SP - 223

EP - 250

JO - EUR UROL

JF - EUR UROL

SN - 0302-2838

IS - 2

ER -