EAU–ESMO consensus statements on the management of advanced and variant bladder cancer—an international collaborative multi-stakeholder effort: under the auspices of the EAU and ESMO Guidelines Committees

A. Horwich; M. Babjuk; J. Bellmunt; H. M. Bruins; T. M. De Reijke; M. De Santis; S. Gillessen; N. James; S. Maclennan; J. Palou; T. Powles; M. J. Ribal; S. F. Shariat; T. Van Der Kwast; E. Xylinas; N. Agarwal; T. Arends; A. Bamias; A. Birtle; P. C. Black; B. H. Bochner; M. Bolla; J. L. Boormans; A. Bossi; A. Briganti; I. Brummelhuis; M. Burger; D. Castellano; R. Cathomas; A. Chiti; A. Choudhury; E. Compérat; S. Crabb; S. Culine; B. De Bari; W. DeBlok; P. J.L. De Visschere; K. Decaestecker; K. Dimitropoulos; J. L. Dominguez-Escrig; S. Fanti; V. Fonteyne; M. Frydenberg; J. J. Futterer; G. Gakis; B. Geavlete; P. Gontero; B. Grubmüller; S. Hafeez; D. E. Hansel; A. Hartmann; D. Hayne; A. M. Henry; V. Hernandez; H. Herr; K. Herrmann; P. Hoskin; J. Huguet; B. A. Jereczek-Fossa; R. Jones; A. M. Kamat; V. Khoo; A. E. Kiltie; S. Krege; S. Ladoire; P. C. Lara; A. Leliveld; E. Linares-Espinós; V. Løgager; A. Lorch; Y. Loriot; R. Meijer; M. Carmen Mir; M. Moschini; H. Mostafid; A. C. Müller; C. R. Müller; J. N'Dow; A. Necchi; Y. Neuzillet; J. R. Oddens; J. Oldenburg; S. Osanto; W. J.G. Oyen; L. Pacheco-Figueiredo; H. Pappot; M. I. Patel; B. R. Pieters; K. Plass; M. Remzi; M. Retz; J. Richenberg; M. Rink; F. Roghmann; J. E. Rosenberg; M. Rouprêt; O. Rouvière; C. Salembier; A. Salminen; P. Sargos; S. Sengupta; A. Sherif; R. J. Smeenk; A. Smits; A. Stenzl; G. N. Thalmann; B. Tombal; B. Turkbey; S. Vahr Lauridsen; R. Valdagni; A. G. Van Der Heijden; H. Van Poppel; M. D. Vartolomei; E. Veskimäe; A. Vilaseca; F. A. Vives Rivera; T. Wiegel; P. Wiklund; A. Williams; R. Zigeuner; J. A. Witjes

doi:10.1093/annonc/mdz296

EAU–ESMO consensus statements on the management of advanced and variant bladder cancer—an international collaborative multi-stakeholder effort: under the auspices of the EAU and ESMO Guidelines Committees

A. Horwich, M. Babjuk, J. Bellmunt, H. M. Bruins, T. M. De Reijke, M. De Santis, S. Gillessen, N. James, S. Maclennan, J. Palou, T. Powles, M. J. Ribal, S. F. Shariat, T. Van Der Kwast, E. Xylinas, N. Agarwal, T. Arends, A. Bamias, A. Birtle, P. C. BlackB. H. Bochner, M. Bolla, J. L. Boormans, A. Bossi, A. Briganti, I. Brummelhuis, M. Burger, D. Castellano, R. Cathomas, A. Chiti, A. Choudhury, E. Compérat, S. Crabb, S. Culine, B. De Bari, W. DeBlok, P. J.L. De Visschere, K. Decaestecker, K. Dimitropoulos, J. L. Dominguez-Escrig, S. Fanti, V. Fonteyne, M. Frydenberg, J. J. Futterer, G. Gakis, B. Geavlete, P. Gontero, B. Grubmüller, S. Hafeez, D. E. Hansel, A. Hartmann, D. Hayne, A. M. Henry, V. Hernandez, H. Herr, K. Herrmann, P. Hoskin, J. Huguet, B. A. Jereczek-Fossa, R. Jones, A. M. Kamat, V. Khoo, A. E. Kiltie, S. Krege, S. Ladoire, P. C. Lara, A. Leliveld, E. Linares-Espinós, V. Løgager, A. Lorch, Y. Loriot, R. Meijer, M. Carmen Mir, M. Moschini, H. Mostafid, A. C. Müller, C. R. Müller, J. N'Dow, A. Necchi, Y. Neuzillet, J. R. Oddens, J. Oldenburg, S. Osanto, W. J.G. Oyen, L. Pacheco-Figueiredo, H. Pappot, M. I. Patel, B. R. Pieters, K. Plass, M. Remzi, M. Retz, J. Richenberg, M. Rink, F. Roghmann, J. E. Rosenberg, M. Rouprêt, O. Rouvière, C. Salembier, A. Salminen, P. Sargos, S. Sengupta, A. Sherif, R. J. Smeenk, A. Smits, A. Stenzl, G. N. Thalmann, B. Tombal, B. Turkbey, S. Vahr Lauridsen, R. Valdagni, A. G. Van Der Heijden, H. Van Poppel, M. D. Vartolomei, E. Veskimäe, A. Vilaseca, F. A. Vives Rivera, T. Wiegel, P. Wiklund, A. Williams, R. Zigeuner, J. A. Witjes

Pathology

Research output: Contribution to journal › Article › peer-review

58 Scopus citations

Abstract

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 before 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), 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, 33 (28%) statements achieved level 1 consensus and 49 (42%) statements 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 where further evidence is available to guide our approach.

Original language	English (US)
Pages (from-to)	1697-1727
Number of pages	31
Journal	Annals of Oncology
Volume	30
Issue number	11
DOIs	https://doi.org/10.1093/annonc/mdz296
State	Published - Nov 2019

Keywords

Delphi
bladder cancer
consensus
diagnosis
follow-up
treatment

ASJC Scopus subject areas

Hematology
Oncology

Access to Document

10.1093/annonc/mdz296

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Horwich, A., Babjuk, M., Bellmunt, J., Bruins, H. M., De Reijke, T. M., De Santis, M., Gillessen, S., James, N., Maclennan, S., Palou, J., Powles, T., Ribal, M. J., Shariat, S. F., Van Der Kwast, T., Xylinas, E., Agarwal, N., Arends, T., Bamias, A., Birtle, A., ... Witjes, J. A. (2019). EAU–ESMO consensus statements on the management of advanced and variant bladder cancer—an international collaborative multi-stakeholder effort: under the auspices of the EAU and ESMO Guidelines Committees. Annals of Oncology, 30(11), 1697-1727. https://doi.org/10.1093/annonc/mdz296

EAU–ESMO consensus statements on the management of advanced and variant bladder cancer—an international collaborative multi-stakeholder effort: under the auspices of the EAU and ESMO Guidelines Committees. / Horwich, A.; Babjuk, M.; Bellmunt, J. et al.
In: Annals of Oncology, Vol. 30, No. 11, 11.2019, p. 1697-1727.

Research output: Contribution to journal › Article › peer-review

Horwich, A, Babjuk, M, Bellmunt, J, Bruins, HM, De Reijke, TM, De Santis, M, Gillessen, S, James, N, Maclennan, S, Palou, J, Powles, T, Ribal, MJ, Shariat, SF, Van Der Kwast, T, Xylinas, E, Agarwal, N, Arends, T, Bamias, A, Birtle, A, Black, PC, Bochner, BH, Bolla, M, Boormans, JL, Bossi, A, Briganti, A, Brummelhuis, I, Burger, M, Castellano, D, Cathomas, R, Chiti, A, Choudhury, A, Compérat, E, Crabb, S, Culine, S, De Bari, B, DeBlok, W, De Visschere, PJL, Decaestecker, K, Dimitropoulos, K, Dominguez-Escrig, JL, Fanti, S, Fonteyne, V, Frydenberg, M, Futterer, JJ, Gakis, G, Geavlete, B, Gontero, P, Grubmüller, B, Hafeez, S, Hansel, DE, Hartmann, A, Hayne, D, Henry, AM, Hernandez, V, Herr, H, Herrmann, K, Hoskin, P, Huguet, J, Jereczek-Fossa, BA, Jones, R, Kamat, AM, Khoo, V, Kiltie, AE, Krege, S, Ladoire, S, Lara, PC, Leliveld, A, Linares-Espinós, E, Løgager, V, Lorch, A, Loriot, Y, Meijer, R, Carmen Mir, M, Moschini, M, Mostafid, H, Müller, AC, Müller, CR, N'Dow, J, Necchi, A, Neuzillet, Y, Oddens, JR, Oldenburg, J, Osanto, S, Oyen, WJG, Pacheco-Figueiredo, L, Pappot, H, Patel, MI, Pieters, BR, Plass, K, Remzi, M, Retz, M, Richenberg, J, Rink, M, Roghmann, F, Rosenberg, JE, Rouprêt, M, Rouvière, O, Salembier, C, Salminen, A, Sargos, P, Sengupta, S, Sherif, A, Smeenk, RJ, Smits, A, Stenzl, A, Thalmann, GN, Tombal, B, Turkbey, B, Vahr Lauridsen, S, Valdagni, R, Van Der Heijden, AG, Van Poppel, H, Vartolomei, MD, Veskimäe, E, Vilaseca, A, Vives Rivera, FA, Wiegel, T, Wiklund, P, Williams, A, Zigeuner, R & Witjes, JA 2019, 'EAU–ESMO consensus statements on the management of advanced and variant bladder cancer—an international collaborative multi-stakeholder effort: under the auspices of the EAU and ESMO Guidelines Committees', Annals of Oncology, vol. 30, no. 11, pp. 1697-1727. https://doi.org/10.1093/annonc/mdz296

@article{7707600198f147d8b9f08b4032a3e182,

title = "EAU–ESMO consensus statements on the management of advanced and variant bladder cancer—an international collaborative multi-stakeholder effort: under the auspices of the EAU and ESMO Guidelines Committees",

abstract = "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 before 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), 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, 33 (28%) statements achieved level 1 consensus and 49 (42%) statements 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 where further evidence is available to guide our approach.",

keywords = "Delphi, bladder cancer, consensus, diagnosis, follow-up, treatment",

author = "A. Horwich and M. Babjuk and J. Bellmunt and Bruins, {H. M.} and {De Reijke}, {T. M.} and {De Santis}, M. and S. Gillessen and N. James and S. Maclennan and J. Palou and T. Powles and Ribal, {M. J.} and Shariat, {S. F.} and {Van Der Kwast}, T. and E. Xylinas and N. Agarwal and T. Arends and A. Bamias and A. Birtle and Black, {P. C.} and Bochner, {B. H.} and M. Bolla and Boormans, {J. L.} and A. Bossi and A. Briganti and I. Brummelhuis and M. Burger and D. Castellano and R. Cathomas and A. Chiti and A. Choudhury and E. Comp{\'e}rat and S. Crabb and S. Culine and {De Bari}, B. and W. DeBlok and {De Visschere}, {P. J.L.} and K. Decaestecker and K. Dimitropoulos and Dominguez-Escrig, {J. L.} and S. Fanti and V. Fonteyne and M. Frydenberg and Futterer, {J. J.} and G. Gakis and B. Geavlete and P. Gontero and B. Grubm{\"u}ller and S. Hafeez and Hansel, {D. E.} and A. Hartmann and D. Hayne and Henry, {A. M.} and V. Hernandez and H. Herr and K. Herrmann and P. Hoskin and J. Huguet and Jereczek-Fossa, {B. A.} and R. Jones and Kamat, {A. M.} and V. Khoo and Kiltie, {A. E.} and S. Krege and S. Ladoire and Lara, {P. C.} and A. Leliveld and E. Linares-Espin{\'o}s and V. L{\o}gager and A. Lorch and Y. Loriot and R. Meijer and {Carmen Mir}, M. and M. Moschini and H. Mostafid and M{\"u}ller, {A. C.} and M{\"u}ller, {C. R.} and J. N'Dow and A. Necchi and Y. Neuzillet and Oddens, {J. R.} and J. Oldenburg and S. Osanto and Oyen, {W. J.G.} and L. Pacheco-Figueiredo and H. Pappot and Patel, {M. I.} and Pieters, {B. R.} and K. Plass and M. Remzi and M. Retz and J. Richenberg and M. Rink and F. Roghmann and Rosenberg, {J. E.} and M. Roupr{\^e}t and O. Rouvi{\`e}re and C. Salembier and A. Salminen and P. Sargos and S. Sengupta and A. Sherif and Smeenk, {R. J.} and A. Smits and A. Stenzl and Thalmann, {G. N.} and B. Tombal and B. Turkbey and {Vahr Lauridsen}, S. and R. Valdagni and {Van Der Heijden}, {A. G.} and {Van Poppel}, H. and Vartolomei, {M. D.} and E. Veskim{\"a}e and A. Vilaseca and {Vives Rivera}, {F. A.} and T. Wiegel and P. Wiklund and A. Williams and R. Zigeuner and Witjes, {J. A.}",

note = "Funding Information: The authors would like to thank Peter E. Clark from Atrium Health, Levine Cancer Institute, Charlotte, NC, USA, for his contribution to the Delphi survey. Angela Corstorphine of Kstorfin Medical Communications Ltd provided medical writing support with the preparation of this manuscript; this support was funded jointly by EAU and ESMO. All costs relating to the consensus conference were covered jointly by the European Association of Urology and the European Society for Medical Oncology (no grant numbers are applicable). There was no external funding of the event or manuscript production. European Association of Urology10.13039/501100003083, European Society for Medical Oncology10.13039/501100007075, AstraZeneca10.13039/100004325, N Agarwal: consultancy to Astellas, AstraZeneca, Argos, BMS, Bayer, Clovis, Eisai, Exelixis, EMD Serono, Ely Lilly, Foundation One, Genentech, Janssen, Merck, Medivation, Novartis, Nektar, Pfizer, Pharmacyclics; research funding (to institution) from AstraZeneca, Bavarian Nordic, BMS, Calithera, Celldex, Eisai, Exelixis, Genetech, GSK, Immunomedics, Janssen, Medivation, Merck, New link Genetics, Novartis, Pfizer, Prometheus, Rexahn, Sanofi, Takeda, Tracon, Bayer, Clovis, EMD Serono, Ely Lilly, Janssen, Nektar. M Babjuk: consultant activities for Roche, MSD, Olympus, Ipsen, Ferring. A Bamias: steering committee member and advisor for Roche; research support, honoraria and advisor for BMS, MSD; research support from AstraZeneca, BMS. J Bellmunt: lecture fees, advisory boards, institutional research funding/support from Pfizer; lecture fees and advisory boards for Merck, AstraZeneca, BMS, Pierre Fabre; institutional research funding/support from Merck GmbH, Takeda. A Birtle: advisory boards for Roche, MSD. PC Black: research support from GenomeDx Biosciences; clinical trial support, advisory board and speaker for Roche/Genentech; advisory boards for Merck, BMS, AstraZeneca, Urogen, Abbvie, Bayer, Lilly, Spectrum, Allergan, Biocancell, Asieris; advisory boards and speaker for Janssen, Sanofi, Ferring; speaker for BioSyent; grants from iProgen, New B Innovation. M Bolla: lecture fees and travel support from AstraZeneca, Ipsen, Janssen. JL Boormans: personal fees for consultancy work from BMS, Merck, Roche; advisory board fees from Janssen; research grant from GenomeDx Biosciences. A Briganti: personal fees from Astellas, Janssen, Opko Health, MDx Health, Bayer, Ferring; grant/research support from Sandoz. M Burger: consultant for Medac GmbH; speaker honorarium from Medac GmbH. D Castellano: personal fees, speaker and advisory boards for Roche, Pfizer, Janssen, Astellas, MSD, Bayer, AstraZeneca, Lilly, Novartis, BMS, Ipsen. R Cathomas: personal fees from Roche, Pfizer, MSD, BMS, AstraZeneca, Janssen, Astellas, Bayer, Sanofi Aventis, Debiopharm, Novartis, Ipsen. A Chiti: personal fees from General Electric, Blue Earth Diagnostics, Sirtex Medical System, Advanced Accelerator Applications; grant from Sanofi Genzyme. A Choudhury: non-financial support from EAU; grants from Cancer Research UK, Prostate Cancer Research UK, Medical Research Council; research support from the Manchester Biomedical Research Centre. S Crabb: grant/research funding and personal fees for advisory work from Clovis Oncology; grant/research funding from Astex Pharmaceuticals; personal fees for advisory work from MSD, Janssen, Roche. S Culine: grant and personal fees from Roche; personal fees from Merck, Janssen; grant from Astellas. W De Blok: grant for development of patient information from Roche, Astellas, Combat Hivec, Hollister, Hoogland Medical, Pfizer. M De Santis: consultant for Amgen, Astellas, AstraZeneca, Bayer, BMS, Celgene, Dendreon, Eisai Inc. ESSA, Ferring, GSK, Incyte, Ipsen, Janssen, Cilag, Merck, MSD, Novartis, Pfizer, Pierre Fabre Oncology, Roche, Sanofi Aventis, Seattle Genetics, Shionogi, Synthon, Takeda, Teva, OncoGenex, Sandoz; speaker honoraria from Amgen, Astellas, AstraZeneca, Bayer, BMS, Ferring, GSK, Ipsen, Janssen Cilag, Merck, MSD, Novartis, Pfizer, Pierre Fabre Oncology, Roche, Sanofi Aventis, Synthon, Takeda; trial participation for Amgen, Astellas, AstraZeneca, Bayer, BMS, Celgene, Dendreon, Eisai Inc. Ferring, GSK, Ipsen, Incyte, Janssen, Cilag, Merck, MSD, Novartis, Pfizer, Pierre Fabre Oncology, Roche, Sanofi Aventis, SOTIO, EORTC GU Group member, IIT (Technische Universit{\"a}t M{\"u}nchen), Exelixis/Ipsen, Incyte, AstraZeneca; grant, fellowship and travel grants from Amgen, Astellas, AstraZeneca, Bayer, BMS, Celgene, Dendreon, Ferring, GSK, Ipsen, Incyte, Janssen Cilag, Merck, MSD, Novartis, Pfizer, Roche, Pierre Fabre Oncology, Sanofi Aventis, Seattle Genetics, Shionogi, Synthon, Takeda, Teva/OncoGenex; grants/research support from Pierre Fabre Oncology; reviewing protocols for EORTC GUCA group; reviewing grants and protocols for Cancer Research UK; reviewer for Annals of Oncology, Journal of Clinical Oncology, European Urology, European Urology Focus, Prostate, European Journal of Cancer, Cancer and New England Journal of Medicine; J Dominguez-Escrig: trial participation for COMBAT BRS, BTS, Presurgy, Ipsen, STORZ, Arguer, Angiodynamics. S Fanti: advisory boards for Bayer, Astellas. S Gillessen: pending patent application for a method for biomarker WO 2009138392 A1; advisory boards fees from Astellas Pharma, CureVac, Janssen Cilag, Pfizer, Sanofi Aventis Group, Bayer, Dendreon Corporation, Millenium Pharmaceuticals, Orion, Sanofi, Roche; advisory boards fees paid to institution from Bayer, Novartis, Astellas Pharma, Janssen Cilag, Roche, AAA International, BMS, CureVac, Ferring, Sanofi, Orion, Innocrin Pharmaceuticals, Clovis, CellSearch, Menarini; uncompensated advisory boards for Menarini, Astellas Pharma, Bayer, ESSA Pharmaceuticals Corporation, Nectar, ProteoMediX, Sanofi; speaker bureau fees paid to institution from Janssen, Novartis; uncompensated speaker bureau for Amgen, Astellas Pharma, Bayer, Janssen, Sanofi Aventis Group; independent data monitoring committee (IDMC) fees from MaxiVAX SA; independent data monitoring committee fees paid to institution from Active Biotech AB, Janssen Cilag. P Gontero: grant from Ipsen; advisory board fees from Arkuer, Cepheid, Ferring. S Hafeez: grant from the National Institute for Health Research (NIHR) Biomedical Research Centre at the Royal Marsden NHS Foundation Trust and the Institute of Cancer Research; non-financial support from Elekta (Elekta AB, Stockholm, Sweden), MSD. DE Hansel: advisory boards for AstraZeneca, Genentech; consultant for Taris. A Hartmann: grants and personal fees from Roche, Janssen, Cepheid; grants from Qiagen, Biontech; personal fees from AstraZeneca, Diaceutics, BMS, MSD, Abbvie, Boehringer Ingelheim. K Herrmann: personal fees for speaker bureau and consultancy from Bayer; personal fees for speaker bureau from Sirtex; board member of Sofie Biosciences; research material support from ABX; advisory board fees from Adacap, Curium, Endocyte, Ipsen; grant and personal fees from BTG; advisory board fees and collaboration with Siemens Healthineers; non-financial support and collaboration with GE Healthcare. P Hoskin: research support from the Manchester Biomedical Research Centre. N James: trial funding as investigator and chief investigator from Cancer Research UK and the UK National Cancer Research Network. BA Jereczek-Fossa: research funding from Accuray (institutional grant), AIRC Italian Association for Cancer Research (institutional grants); travel expenses or speaker fees from Janssen, Ferring, Bayer, Roche, Astellas, Elekta, Carl Zeiss, Ipsen. R Jones: research grant, honoraria for advisory board, speaker honoraria and trial funding for institution from Roche; travel support, honoraria for advisory board, speaker honoraria and trial funding for institution from MSD; speaker honoraria and trial funding for institution from Merck Serono; honoraria for speaker and advisory board and trial funding for institution from BMS. A Kamat: personal fees for advisory board and consulting and research funding from Merck; personal fees for advisory boards and consulting from BMS, Photocure, Elsai, Arquer, MDx Health, AstraZeneca, Abbott Molecular, US Biotest, Ferring, BioClin; research funding from FKD Industries. V Khoo: personal fees for lecture from Astellas; personal fees and non-financial support for lecture, meeting and educational attendance from Bayer; non-financial support for meeting and educational attendance from Janssen. A Lorch: principal investigator for phase II and III trials with Roche, MSD, AstraZeneca, Ipsen, Janssen, Bayer, Novartis, BMS; advisory boards for Roche, Novartis, Ipsen, MSD, BMS, Janssen; honoraria for lectures and travel fees from Roche, AstraZeneca, Novartis, Ipsen; travel fees from MSD. Y Loriot: grant, personal fees and non-financial support from Janssen, MSD; personal fees and non-financial support from Astellas, Roche, AstraZeneca, BMS, Seattle Genetics; grant and personal fees from Sanofi; personal fees from Clovis, Incyte, Pfizer. R Meijer: advisory board fees from Janssen; speaker fees from Roche, Bayer; research funding from Roche, Janssen. A-C M{\"u}ller: financial and technical support to institution under a research agreement from Elekta, Philips, Siemens; sponsorship for travel and scientific symposia from Opaska. A Necchi: grant and personal fees from Merck, BMS, AstraZeneca, Incyte; personal fees from Roche, Bayer, Janssen, BioClin Therapeutics, Clovis Oncology. Y Neuzillet: consultant for Astellas, AstraZeneca, Bouchara-Recordati, BMS, Ipsen, Janssen, Medac, MSD, Roche, Sanofi Pasteur, Sanofi Aventis. J Oddens: speaker fees from Janssen, Astellas; advisory board fees from Amgen. S Osanto: advisory boards fees paid to institution from Bayer, Eisai, Novartis, Janssen Cilag, Roche, BMS, Pfizer; institutional research funding/support from Ipsen; travel support from Bayer. L Pacheco-Figueiredo: personal fees from Lilly Farma, Lda; non-financial support from Laborat{\'o}rios Pfizer Portugal, Lda, Jaba Recordati, S.A. Menarini Portugal. J Palou: honoraria or consultation fees from Combat BRS, Olympus, Sanofi Pasteur, Cepheid; trial participation for Ipsen, COMBAT BRS, Presurgy, STORZ, Archer. H Pappot: research grants from MSD, Roche; lecture fees from BMS. B R Pieters: grant/research funding from Elekta. T Powles: consultant, speaker honoraria, research support/grants from Novartis, Pfizer, Pierre Fabre Oncology, Roche, Sanofi Aventis, Seattle Genetics; consultant, speaker honoraria, trial participation and research support/grants from Pfizer, GlaxoSmithKline; speaker honoraria and trial participation for Genentech; grant and personal fees for trial participation from BMS, MSD, Merck, Ipsen, Exelexis, Seattle Genetics, AstraZeneca. M Remzi: advisory board and/or speaker for Astellas, Bayer, Ipsen, Janssen, Pfizer, Baxter, Novartis. M Retz: presentations and advisory boards for Astellas, AstraZeneca, BMS, Ipsen, Janssen-Cilag, MSD, Pfizer, Roche; scientific support from BMS. M J Ribal: speaker honoraria from Astellas, Janssen, Ipsen, Olympus. M Rink: advisory board and/or speaker for BMS, Ipsen, MSD, Pfizer, Roche. F Roghmann: personal fees from Ipsen, Roche, Novartis, Janssen. JE Rosenberg: clinical trial funding and personal fees from Astellas, Seattle Genetics, AstraZeneca, Mirati, Bayer; clinical trial funding, personal fees and non-financial support from Roche; personal fees and non-financial support from BMS; personal fees and stock from Merck; personal fees from Lilly, EMD Serono, Adicet Bio, Inovio, QED Therapeutics, Ranier (Bioclin) Therapeutics, Sensei Biotherapeutics, Chugai Pharma, Western Oncolytics, Pharmacyclics, GSK, Janssen. M Roupr{\^e}t: grants/research support from GSK, Pfizer, Roche; honoraria or consultation fees from Lilly, GSK, Ipsen, Astellas, Takeda, Sanofi Pasteur, Medac. O Rouvi{\`e}re: travel expenses from Philips. A Salminen: lecture fee from Roche. P Sargos: grants/research support from Ipsen, AstraZeneca; honoraria or consultancy fees from Astellas, Janssen, Bayer, Ipsen, Ferring, Recordati, Roche, Sanofi, Nanobiotix, Takeda. S Sengupta: speaker honorarium (donated to institutional research fund) from Mundipharma Australia, Ipsen Australia, MSD Australia, Eastern Melbourne Primary health network; consulting honorarium for advisory board (donated to institutional research fund) from Janssen Australia. S Shariat: honoraria, consulting or advisory role and speaker bureau for Astellas, AstraZeneca, Bayer, BMS, Cepheid, Ferring, Ipsen, Janssen, Lilly, MSD, Olympus, Pfizer, Pierre Fabre, Richard Wolf Roche, Sanochemia, Sanofi, Urogen; patents: method to determine prognosis after therapy for prostate cancer granted 2002-09-06, methods to determine prognosis after therapy for bladder cancer granted 2003-06-19, prognostic methods for patients with prostatic disease granted 2004-08-05, soluble Fas urinary marker for the detection of bladder transitional cell carcinoma granted 2010-07-20. A Stenzl: advisory boards for BMS, Stebabiotech, Synergo; advisory board/consultant for Ipsen Pharma, Roche, Janssen, Alere; speaker for Janssen, Ipsen Pharma, Sanofi Aventis, CureVac, Astellas; clinical studies for Johnson & Johnson, Roche, Cepheid, Roche, Bayer AG, CureVac, Immatics biotechnologies GmbH, GemeDx Biosciences; research grants from Amgen Inc, Immatics biotechnologies GmbH, Novartis AG, Karl Storz AG. B Tombal: personal fees from Amgen, Astellas, Bayer, Ferring, Janssen, Sanofi. T Van Der Kwast: consultant activities for Janssen. T Wiegel: advisory board for Ipsen; speaker honorarium from Ipsen, Hexal; trial participation for Atlas trial; member of steering committee for Janssen. JA Witjes: personal fees as advisor for Roche, Merck, BMS. R Zigeuner: fellowships, travel grants, company grants, research support and speaker honoraria from Bayer Healthcare; fellowships, travel grants, consultant and speaker honoraria from Pfizer; speaker honoraria, fellowships and travel grants from Novartis, Astellas, Takeda; fellowships, travel grants and speaker honoraria from Amgen, GSK; speaker honoraria from Roche, BMS and Eisai. All remaining authors have declared no conflicts of interest. Funding Information: The authors would like to thank Peter E. Clark from Atrium Health, Levine Cancer Institute, Charlotte, NC, USA, for his contribution to the Delphi survey. Angela Corstorphine of Kstorfin Medical Communications Ltd provided medical writing support with the preparation of this manuscript; this support was funded jointly by EAU and ESMO. Publisher Copyright: {\textcopyright} 2019 European Society for Medical Oncology",

year = "2019",

month = nov,

doi = "10.1093/annonc/mdz296",

language = "English (US)",

volume = "30",

pages = "1697--1727",

journal = "Annals of Oncology",

issn = "0923-7534",

publisher = "Oxford University Press",

number = "11",

}

TY - JOUR

T1 - EAU–ESMO consensus statements on the management of advanced and variant bladder cancer—an international collaborative multi-stakeholder effort

T2 - under the auspices of the EAU and ESMO Guidelines Committees

AU - Horwich, A.

AU - Babjuk, M.

AU - Bellmunt, J.

AU - Bruins, H. M.

AU - De Reijke, T. M.

AU - De Santis, M.

AU - Gillessen, S.

AU - James, N.

AU - Maclennan, S.

AU - Palou, J.

AU - Powles, T.

AU - Ribal, M. J.

AU - Shariat, S. F.

AU - Van Der Kwast, T.

AU - Xylinas, E.

AU - Agarwal, N.

AU - Arends, T.

AU - Bamias, A.

AU - Birtle, A.

AU - Black, P. C.

AU - Bochner, B. H.

AU - Bolla, M.

AU - Boormans, J. L.

AU - Bossi, A.

AU - Briganti, A.

AU - Brummelhuis, I.

AU - Burger, M.

AU - Castellano, D.

AU - Cathomas, R.

AU - Chiti, A.

AU - Choudhury, A.

AU - Compérat, E.

AU - Crabb, S.

AU - Culine, S.

AU - De Bari, B.

AU - DeBlok, W.

AU - De Visschere, P. J.L.

AU - Decaestecker, K.

AU - Dimitropoulos, K.

AU - Dominguez-Escrig, J. L.

AU - Fanti, S.

AU - Fonteyne, V.

AU - Frydenberg, M.

AU - Futterer, J. J.

AU - Gakis, G.

AU - Geavlete, B.

AU - Gontero, P.

AU - Grubmüller, B.

AU - Hafeez, S.

AU - Hansel, D. E.

AU - Hartmann, A.

AU - Hayne, D.

AU - Henry, A. M.

AU - Hernandez, V.

AU - Herr, H.

AU - Herrmann, K.

AU - Hoskin, P.

AU - Huguet, J.

AU - Jereczek-Fossa, B. A.

AU - Jones, R.

AU - Kamat, A. M.

AU - Khoo, V.

AU - Kiltie, A. E.

AU - Krege, S.

AU - Ladoire, S.

AU - Lara, P. C.

AU - Leliveld, A.

AU - Linares-Espinós, E.

AU - Løgager, V.

AU - Lorch, A.

AU - Loriot, Y.

AU - Meijer, R.

AU - Carmen Mir, M.

AU - Moschini, M.

AU - Mostafid, H.

AU - Müller, A. C.

AU - Müller, C. R.

AU - N'Dow, J.

AU - Necchi, A.

AU - Neuzillet, Y.

AU - Oddens, J. R.

AU - Oldenburg, J.

AU - Osanto, S.

AU - Oyen, W. J.G.

AU - Pacheco-Figueiredo, L.

AU - Pappot, H.

AU - Patel, M. I.

AU - Pieters, B. R.

AU - Plass, K.

AU - Remzi, M.

AU - Retz, M.

AU - Richenberg, J.

AU - Rink, M.

AU - Roghmann, F.

AU - Rosenberg, J. E.

AU - Rouprêt, M.

AU - Rouvière, O.

AU - Salembier, C.

AU - Salminen, A.

AU - Sargos, P.

AU - Sengupta, S.

AU - Sherif, A.

AU - Smeenk, R. J.

AU - Smits, A.

AU - Stenzl, A.

AU - Thalmann, G. N.

AU - Tombal, B.

AU - Turkbey, B.

AU - Vahr Lauridsen, S.

AU - Valdagni, R.

AU - Van Der Heijden, A. G.

AU - Van Poppel, H.

AU - Vartolomei, M. D.

AU - Veskimäe, E.

AU - Vilaseca, A.

AU - Vives Rivera, F. A.

AU - Wiegel, T.

AU - Wiklund, P.

AU - Williams, A.

AU - Zigeuner, R.

AU - Witjes, J. A.

N1 - Funding Information: The authors would like to thank Peter E. Clark from Atrium Health, Levine Cancer Institute, Charlotte, NC, USA, for his contribution to the Delphi survey. Angela Corstorphine of Kstorfin Medical Communications Ltd provided medical writing support with the preparation of this manuscript; this support was funded jointly by EAU and ESMO. All costs relating to the consensus conference were covered jointly by the European Association of Urology and the European Society for Medical Oncology (no grant numbers are applicable). There was no external funding of the event or manuscript production. European Association of Urology10.13039/501100003083, European Society for Medical Oncology10.13039/501100007075, AstraZeneca10.13039/100004325, N Agarwal: consultancy to Astellas, AstraZeneca, Argos, BMS, Bayer, Clovis, Eisai, Exelixis, EMD Serono, Ely Lilly, Foundation One, Genentech, Janssen, Merck, Medivation, Novartis, Nektar, Pfizer, Pharmacyclics; research funding (to institution) from AstraZeneca, Bavarian Nordic, BMS, Calithera, Celldex, Eisai, Exelixis, Genetech, GSK, Immunomedics, Janssen, Medivation, Merck, New link Genetics, Novartis, Pfizer, Prometheus, Rexahn, Sanofi, Takeda, Tracon, Bayer, Clovis, EMD Serono, Ely Lilly, Janssen, Nektar. M Babjuk: consultant activities for Roche, MSD, Olympus, Ipsen, Ferring. A Bamias: steering committee member and advisor for Roche; research support, honoraria and advisor for BMS, MSD; research support from AstraZeneca, BMS. J Bellmunt: lecture fees, advisory boards, institutional research funding/support from Pfizer; lecture fees and advisory boards for Merck, AstraZeneca, BMS, Pierre Fabre; institutional research funding/support from Merck GmbH, Takeda. A Birtle: advisory boards for Roche, MSD. PC Black: research support from GenomeDx Biosciences; clinical trial support, advisory board and speaker for Roche/Genentech; advisory boards for Merck, BMS, AstraZeneca, Urogen, Abbvie, Bayer, Lilly, Spectrum, Allergan, Biocancell, Asieris; advisory boards and speaker for Janssen, Sanofi, Ferring; speaker for BioSyent; grants from iProgen, New B Innovation. M Bolla: lecture fees and travel support from AstraZeneca, Ipsen, Janssen. JL Boormans: personal fees for consultancy work from BMS, Merck, Roche; advisory board fees from Janssen; research grant from GenomeDx Biosciences. A Briganti: personal fees from Astellas, Janssen, Opko Health, MDx Health, Bayer, Ferring; grant/research support from Sandoz. M Burger: consultant for Medac GmbH; speaker honorarium from Medac GmbH. D Castellano: personal fees, speaker and advisory boards for Roche, Pfizer, Janssen, Astellas, MSD, Bayer, AstraZeneca, Lilly, Novartis, BMS, Ipsen. R Cathomas: personal fees from Roche, Pfizer, MSD, BMS, AstraZeneca, Janssen, Astellas, Bayer, Sanofi Aventis, Debiopharm, Novartis, Ipsen. A Chiti: personal fees from General Electric, Blue Earth Diagnostics, Sirtex Medical System, Advanced Accelerator Applications; grant from Sanofi Genzyme. A Choudhury: non-financial support from EAU; grants from Cancer Research UK, Prostate Cancer Research UK, Medical Research Council; research support from the Manchester Biomedical Research Centre. S Crabb: grant/research funding and personal fees for advisory work from Clovis Oncology; grant/research funding from Astex Pharmaceuticals; personal fees for advisory work from MSD, Janssen, Roche. S Culine: grant and personal fees from Roche; personal fees from Merck, Janssen; grant from Astellas. W De Blok: grant for development of patient information from Roche, Astellas, Combat Hivec, Hollister, Hoogland Medical, Pfizer. M De Santis: consultant for Amgen, Astellas, AstraZeneca, Bayer, BMS, Celgene, Dendreon, Eisai Inc. ESSA, Ferring, GSK, Incyte, Ipsen, Janssen, Cilag, Merck, MSD, Novartis, Pfizer, Pierre Fabre Oncology, Roche, Sanofi Aventis, Seattle Genetics, Shionogi, Synthon, Takeda, Teva, OncoGenex, Sandoz; speaker honoraria from Amgen, Astellas, AstraZeneca, Bayer, BMS, Ferring, GSK, Ipsen, Janssen Cilag, Merck, MSD, Novartis, Pfizer, Pierre Fabre Oncology, Roche, Sanofi Aventis, Synthon, Takeda; trial participation for Amgen, Astellas, AstraZeneca, Bayer, BMS, Celgene, Dendreon, Eisai Inc. Ferring, GSK, Ipsen, Incyte, Janssen, Cilag, Merck, MSD, Novartis, Pfizer, Pierre Fabre Oncology, Roche, Sanofi Aventis, SOTIO, EORTC GU Group member, IIT (Technische Universität München), Exelixis/Ipsen, Incyte, AstraZeneca; grant, fellowship and travel grants from Amgen, Astellas, AstraZeneca, Bayer, BMS, Celgene, Dendreon, Ferring, GSK, Ipsen, Incyte, Janssen Cilag, Merck, MSD, Novartis, Pfizer, Roche, Pierre Fabre Oncology, Sanofi Aventis, Seattle Genetics, Shionogi, Synthon, Takeda, Teva/OncoGenex; grants/research support from Pierre Fabre Oncology; reviewing protocols for EORTC GUCA group; reviewing grants and protocols for Cancer Research UK; reviewer for Annals of Oncology, Journal of Clinical Oncology, European Urology, European Urology Focus, Prostate, European Journal of Cancer, Cancer and New England Journal of Medicine; J Dominguez-Escrig: trial participation for COMBAT BRS, BTS, Presurgy, Ipsen, STORZ, Arguer, Angiodynamics. S Fanti: advisory boards for Bayer, Astellas. S Gillessen: pending patent application for a method for biomarker WO 2009138392 A1; advisory boards fees from Astellas Pharma, CureVac, Janssen Cilag, Pfizer, Sanofi Aventis Group, Bayer, Dendreon Corporation, Millenium Pharmaceuticals, Orion, Sanofi, Roche; advisory boards fees paid to institution from Bayer, Novartis, Astellas Pharma, Janssen Cilag, Roche, AAA International, BMS, CureVac, Ferring, Sanofi, Orion, Innocrin Pharmaceuticals, Clovis, CellSearch, Menarini; uncompensated advisory boards for Menarini, Astellas Pharma, Bayer, ESSA Pharmaceuticals Corporation, Nectar, ProteoMediX, Sanofi; speaker bureau fees paid to institution from Janssen, Novartis; uncompensated speaker bureau for Amgen, Astellas Pharma, Bayer, Janssen, Sanofi Aventis Group; independent data monitoring committee (IDMC) fees from MaxiVAX SA; independent data monitoring committee fees paid to institution from Active Biotech AB, Janssen Cilag. P Gontero: grant from Ipsen; advisory board fees from Arkuer, Cepheid, Ferring. S Hafeez: grant from the National Institute for Health Research (NIHR) Biomedical Research Centre at the Royal Marsden NHS Foundation Trust and the Institute of Cancer Research; non-financial support from Elekta (Elekta AB, Stockholm, Sweden), MSD. DE Hansel: advisory boards for AstraZeneca, Genentech; consultant for Taris. A Hartmann: grants and personal fees from Roche, Janssen, Cepheid; grants from Qiagen, Biontech; personal fees from AstraZeneca, Diaceutics, BMS, MSD, Abbvie, Boehringer Ingelheim. K Herrmann: personal fees for speaker bureau and consultancy from Bayer; personal fees for speaker bureau from Sirtex; board member of Sofie Biosciences; research material support from ABX; advisory board fees from Adacap, Curium, Endocyte, Ipsen; grant and personal fees from BTG; advisory board fees and collaboration with Siemens Healthineers; non-financial support and collaboration with GE Healthcare. P Hoskin: research support from the Manchester Biomedical Research Centre. N James: trial funding as investigator and chief investigator from Cancer Research UK and the UK National Cancer Research Network. BA Jereczek-Fossa: research funding from Accuray (institutional grant), AIRC Italian Association for Cancer Research (institutional grants); travel expenses or speaker fees from Janssen, Ferring, Bayer, Roche, Astellas, Elekta, Carl Zeiss, Ipsen. R Jones: research grant, honoraria for advisory board, speaker honoraria and trial funding for institution from Roche; travel support, honoraria for advisory board, speaker honoraria and trial funding for institution from MSD; speaker honoraria and trial funding for institution from Merck Serono; honoraria for speaker and advisory board and trial funding for institution from BMS. A Kamat: personal fees for advisory board and consulting and research funding from Merck; personal fees for advisory boards and consulting from BMS, Photocure, Elsai, Arquer, MDx Health, AstraZeneca, Abbott Molecular, US Biotest, Ferring, BioClin; research funding from FKD Industries. V Khoo: personal fees for lecture from Astellas; personal fees and non-financial support for lecture, meeting and educational attendance from Bayer; non-financial support for meeting and educational attendance from Janssen. A Lorch: principal investigator for phase II and III trials with Roche, MSD, AstraZeneca, Ipsen, Janssen, Bayer, Novartis, BMS; advisory boards for Roche, Novartis, Ipsen, MSD, BMS, Janssen; honoraria for lectures and travel fees from Roche, AstraZeneca, Novartis, Ipsen; travel fees from MSD. Y Loriot: grant, personal fees and non-financial support from Janssen, MSD; personal fees and non-financial support from Astellas, Roche, AstraZeneca, BMS, Seattle Genetics; grant and personal fees from Sanofi; personal fees from Clovis, Incyte, Pfizer. R Meijer: advisory board fees from Janssen; speaker fees from Roche, Bayer; research funding from Roche, Janssen. A-C Müller: financial and technical support to institution under a research agreement from Elekta, Philips, Siemens; sponsorship for travel and scientific symposia from Opaska. A Necchi: grant and personal fees from Merck, BMS, AstraZeneca, Incyte; personal fees from Roche, Bayer, Janssen, BioClin Therapeutics, Clovis Oncology. Y Neuzillet: consultant for Astellas, AstraZeneca, Bouchara-Recordati, BMS, Ipsen, Janssen, Medac, MSD, Roche, Sanofi Pasteur, Sanofi Aventis. J Oddens: speaker fees from Janssen, Astellas; advisory board fees from Amgen. S Osanto: advisory boards fees paid to institution from Bayer, Eisai, Novartis, Janssen Cilag, Roche, BMS, Pfizer; institutional research funding/support from Ipsen; travel support from Bayer. L Pacheco-Figueiredo: personal fees from Lilly Farma, Lda; non-financial support from Laboratórios Pfizer Portugal, Lda, Jaba Recordati, S.A. Menarini Portugal. J Palou: honoraria or consultation fees from Combat BRS, Olympus, Sanofi Pasteur, Cepheid; trial participation for Ipsen, COMBAT BRS, Presurgy, STORZ, Archer. H Pappot: research grants from MSD, Roche; lecture fees from BMS. B R Pieters: grant/research funding from Elekta. T Powles: consultant, speaker honoraria, research support/grants from Novartis, Pfizer, Pierre Fabre Oncology, Roche, Sanofi Aventis, Seattle Genetics; consultant, speaker honoraria, trial participation and research support/grants from Pfizer, GlaxoSmithKline; speaker honoraria and trial participation for Genentech; grant and personal fees for trial participation from BMS, MSD, Merck, Ipsen, Exelexis, Seattle Genetics, AstraZeneca. M Remzi: advisory board and/or speaker for Astellas, Bayer, Ipsen, Janssen, Pfizer, Baxter, Novartis. M Retz: presentations and advisory boards for Astellas, AstraZeneca, BMS, Ipsen, Janssen-Cilag, MSD, Pfizer, Roche; scientific support from BMS. M J Ribal: speaker honoraria from Astellas, Janssen, Ipsen, Olympus. M Rink: advisory board and/or speaker for BMS, Ipsen, MSD, Pfizer, Roche. F Roghmann: personal fees from Ipsen, Roche, Novartis, Janssen. JE Rosenberg: clinical trial funding and personal fees from Astellas, Seattle Genetics, AstraZeneca, Mirati, Bayer; clinical trial funding, personal fees and non-financial support from Roche; personal fees and non-financial support from BMS; personal fees and stock from Merck; personal fees from Lilly, EMD Serono, Adicet Bio, Inovio, QED Therapeutics, Ranier (Bioclin) Therapeutics, Sensei Biotherapeutics, Chugai Pharma, Western Oncolytics, Pharmacyclics, GSK, Janssen. M Rouprêt: grants/research support from GSK, Pfizer, Roche; honoraria or consultation fees from Lilly, GSK, Ipsen, Astellas, Takeda, Sanofi Pasteur, Medac. O Rouvière: travel expenses from Philips. A Salminen: lecture fee from Roche. P Sargos: grants/research support from Ipsen, AstraZeneca; honoraria or consultancy fees from Astellas, Janssen, Bayer, Ipsen, Ferring, Recordati, Roche, Sanofi, Nanobiotix, Takeda. S Sengupta: speaker honorarium (donated to institutional research fund) from Mundipharma Australia, Ipsen Australia, MSD Australia, Eastern Melbourne Primary health network; consulting honorarium for advisory board (donated to institutional research fund) from Janssen Australia. S Shariat: honoraria, consulting or advisory role and speaker bureau for Astellas, AstraZeneca, Bayer, BMS, Cepheid, Ferring, Ipsen, Janssen, Lilly, MSD, Olympus, Pfizer, Pierre Fabre, Richard Wolf Roche, Sanochemia, Sanofi, Urogen; patents: method to determine prognosis after therapy for prostate cancer granted 2002-09-06, methods to determine prognosis after therapy for bladder cancer granted 2003-06-19, prognostic methods for patients with prostatic disease granted 2004-08-05, soluble Fas urinary marker for the detection of bladder transitional cell carcinoma granted 2010-07-20. A Stenzl: advisory boards for BMS, Stebabiotech, Synergo; advisory board/consultant for Ipsen Pharma, Roche, Janssen, Alere; speaker for Janssen, Ipsen Pharma, Sanofi Aventis, CureVac, Astellas; clinical studies for Johnson & Johnson, Roche, Cepheid, Roche, Bayer AG, CureVac, Immatics biotechnologies GmbH, GemeDx Biosciences; research grants from Amgen Inc, Immatics biotechnologies GmbH, Novartis AG, Karl Storz AG. B Tombal: personal fees from Amgen, Astellas, Bayer, Ferring, Janssen, Sanofi. T Van Der Kwast: consultant activities for Janssen. T Wiegel: advisory board for Ipsen; speaker honorarium from Ipsen, Hexal; trial participation for Atlas trial; member of steering committee for Janssen. JA Witjes: personal fees as advisor for Roche, Merck, BMS. R Zigeuner: fellowships, travel grants, company grants, research support and speaker honoraria from Bayer Healthcare; fellowships, travel grants, consultant and speaker honoraria from Pfizer; speaker honoraria, fellowships and travel grants from Novartis, Astellas, Takeda; fellowships, travel grants and speaker honoraria from Amgen, GSK; speaker honoraria from Roche, BMS and Eisai. All remaining authors have declared no conflicts of interest. Funding Information: The authors would like to thank Peter E. Clark from Atrium Health, Levine Cancer Institute, Charlotte, NC, USA, for his contribution to the Delphi survey. Angela Corstorphine of Kstorfin Medical Communications Ltd provided medical writing support with the preparation of this manuscript; this support was funded jointly by EAU and ESMO. Publisher Copyright: © 2019 European Society for Medical Oncology

PY - 2019/11

Y1 - 2019/11

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 before 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), 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, 33 (28%) statements achieved level 1 consensus and 49 (42%) statements 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 where further evidence is available to guide our approach.

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 before 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), 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, 33 (28%) statements achieved level 1 consensus and 49 (42%) statements 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 where further evidence is available to guide our approach.

KW - Delphi

KW - bladder cancer

KW - consensus

KW - diagnosis

KW - follow-up

KW - treatment

UR - http://www.scopus.com/inward/record.url?scp=85077175940&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85077175940&partnerID=8YFLogxK

U2 - 10.1093/annonc/mdz296

DO - 10.1093/annonc/mdz296

M3 - Article

C2 - 31740927

AN - SCOPUS:85077175940

SN - 0923-7534

VL - 30

SP - 1697

EP - 1727

JO - Annals of Oncology

JF - Annals of Oncology

IS - 11

ER -

EAU–ESMO consensus statements on the management of advanced and variant bladder cancer—an international collaborative multi-stakeholder effort: under the auspices of the EAU and ESMO Guidelines Committees

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