González Del Alba, ADe Velasco, GLainez, NMaroto, PMorales-Barrera, RMuñoz-Langa, JPérez-Valderrama, BBasterretxea, LCaballero, CVazquez, S2023-01-252023-01-252018-12-18http://hdl.handle.net/10668/13329The goal of this article is to provide recommendations about the management of muscle-invasive (MIBC) and metastatic bladder cancer. New molecular subtypes of MIBC are associated with specific clinical-pathological characteristics. Radical cystectomy and lymph node dissection are the gold standard for treatment and neoadjuvant chemotherapy with a cisplatin-based combination should be recommended in fit patients. The role of adjuvant chemotherapy in MIBC remains controversial; its use must be considered in patients with high-risk who are able to tolerate a cisplatin-based regimen, and have not received neoadjuvant chemotherapy. Bladder-preserving approaches are reasonable alternatives to cystectomy in selected patients for whom cystectomy is not contemplated either for clinical or personal reasons. Cisplatin-based combination chemotherapy is the standard first-line protocol for metastatic disease. In the case of unfit patients, carboplatin-gemcitabine should be considered the preferred first-line chemotherapy treatment option, while pembrolizumab and atezolizumab can be contemplated for individuals with high PD-L1 expression. In cases of progression after platinum-based therapy, PD-1/PD-L1 inhibitors are standard alternatives. Vinflunine is another option when anti-PD-1/PD-L1 therapy is not possible. There are no data from randomized clinical trials regarding moving on to immuno-oncology agents.enAttribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/Bladder cancerChemotherapyCystectomyImmune checkpoint inhibitorsClinical Trials as TopicCombined Modality TherapyDisease ManagementHumansMuscle NeoplasmsNeoplasm InvasivenessPractice Guidelines as TopicPrognosisSocieties, MedicalUrinary Bladder Neoplasmsresearch article30565086open access10.1007/s12094-018-02001-x1699-3055PMC6339669https://link.springer.com/content/pdf/10.1007/s12094-018-02001-x.pdfhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6339669/pdf