French AFU Cancer Committee Guidelines - Update 2024-2026: Muscle- invasive bladder cancer (MIBC)

Objective: To update the CCAFU recommendations for the management of muscle-invasive bladder cancer (MIBC). Methods: A systematic review (Medline) of the literature from 2022 to 2024 was carried out, taking into account the elements of the diagnosis, the treatment options and the monitoring of NMIBC and MIBC, evaluating the references with their level of evidence. Results: MIBC is diagosed after the must complete tumor resection possible. CT-Urography coupled with chest CT scans are used to assess the extent of MIBC. Multiparametric pelvic MRI may be an alternative imaging approach. Cystectomy combined with standard lymph node dissection is the standard treatment for nonmetastatic MIBC. Neoadjuvant cispaltine-based chemotherapy should be used in patients in good general health with satisfactory renal function. Enterocystoplasty is proposed for men and women in the absence of contraindications and when urethral recutting is negative on extemporaneous examination; otherwise, transileal cutaneous ureterostomy is the recommended method of urinary diversion. All patients should be included in an improved recovery after surgery (ERAS) protocol. For metastatic MIBC, first-line treatment with enfortumab vedotin and pembrolizumab is recommended. Second-line treatment with platinum-based chemotherapy is recommended. Conclusion: Updating the ccAFU recommendations should improve patient management and enhance the diagnosis and treatment of MIBC. (c) 2024 Published by Elsevier Masson SAS.