Summary Recommendations

Guideline Recommendations

Use of NACT for MIBC

Neoadjuvant cisplatin-containing combination chemotherapy improves overall survival (Level Ia, Grade A). Neoadjuvant chemotherapy is not recommended in patients with PS >2 and/or impaired renal function (Grade B). Although there is no evidence to suggest that the newer chemotherapy regimens are as effective as the older ones in the neoadjuvant setting, the SCAN workgroup members do not exclude the use of the newer chemotherapy regimens due to better toxicity profiles.

Use of ACT for MIBC

Platinum-based combination not recommended for routine use (Level Ia, Grade A) but can be considered for node positive patients. There is unanimous agreement among the workgroup members that cisplatin-based chemotherapy is not recommended for routine use due to its limited clinical data and evidence. However, as many patients are referred only after surgery, ACT should be considered in patients with high risk of relapse, namely, those with extravesical extension and/or node positive disease due to the possible improvement in DFS.

ACT: Adjuvant chemotherapy; DFS: Disease-free survival; EAU: European Association of Urology; ESMO: European Society for Medical Oncology; MIBC: Muscle-invasive bladder cancer; NACT: Neoadjuvant chemotherapy; PS: Performance status