2024 CUA-GUMOC Expert Report: Management of unresectable locally advanced and metastatic urothelial carcinoma

We conducted a comprehensive literature review evaluating studies of mUC, with an emphasis on RCTs published since the 2019 publication.A search of PubMed, Medline, and Embase, in addition to other published guidelines and abstract presentations at major conferences, were used to identify relevant studies.Wherever possible we sought to align our treatment recommendations with those of international organizations such as American Society of Clinical Oncology (ASCO), National Comprehensive Cancer Network (NCCN), European Society of Medical Oncology (ESMO) and European Association of Urology (EAU); however, full alignment may be limited by differences in clinical practice standards, regional variations, and the availability of approved therapies in Canada.Draft recommendations on various aspects of mUC management, based on best available evidence, were initially developed by the co-first and senior authors.These recommendations were shared with all co-authors via email for input, and revisions were made based on this email discussion.Through this process, consensus was reached by incorporating and addressing all the feedback points, ensuring alignment among the authors.Authorship in this consensus is composed of experts and key opinion leaders in genitourinary medical oncology, uro-oncology, and radiation oncology across Canada.These experts were selected based on their significant clinical experience, academic contributions, and leadership in clinical practice guidelines.A multidisciplinary approach is emphasized, particularly in the setting of locally advanced disease (defined here as cT4b and/or cN1-N3), oligometastatic, or oligoprogressive disease (OPD).