Consensus statements from the Hong Kong Urological Association and the Hong Kong Society of Uro-Oncology on the management of muscleinvasive and advanced urothelial carcinoma

Darren M.C. Poon^1,2Peter K.F. Chiu^3*Marco T.Y. Chan⁴Brian Ho⁵K S Law⁶Angus K.C. Leung⁷Clarence L.H. Leung⁸Rong Na⁹Kenneth C.W. Wong¹⁰Philip Y Wu¹¹Philip W.K. Kwong¹²Jeremy Y.C. Teoh³

• ¹Department of Clinical Oncology, State Key Laboratory of Translational Oncology, Sir YK Pao Centre for Cancer, Hong Kong Cancer Institute, The Chinese University of Hong Kong, Hong Kong, Hong Kong, SAR China
• ²Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong, SAR China
• ³S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR China
• ⁴Division of Urology, Department of Surgery, Tuen Mun Hospital, Hong Kong, Hong Kong, SAR China
• ⁵Division of Urology, Department of Surgery, Queen Mary Hospital, Hong Kong, Hong Kong, SAR China
• ⁶Department of Clinical Oncology, Princess Margaret Hospital, Hongkong, Hong Kong, SAR China
• ⁷AMO Oncology Centre, Kowloon, Hong Kong, SAR China
• ⁸eFLO Urology, Hong Kong, Hong Kong, SAR China
• ⁹Division of Urology, Department of Surgery, The University of Hong Kong, Hong Kong, Hong Kong, SAR China
• ¹⁰Department of Clinical Oncology, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR China
• ¹¹Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, Hong Kong, SAR China
• ¹²Hong Kong Integrated Oncology Centre, Hong Kong, Hong Kong, SAR China

Background: Muscle-invasive and advanced urothelial carcinoma (UC) are notorious for their high propensity for recurrence and metastasis. Recent advances in novel medications, surgical procedures, and radiotherapy techniques have substantially transformed the treatment landscape of muscle- invasive and advanced UC. It is crucial to navigate the optimal management approaches for muscleinvasive and advanced UC through the increasingly complex matrix of variables.Methods: Two professional organisations convened a consensus panel of six urologists and six clinical oncologists with extensive experience in treating urological malignancies. They reviewed the literature on the management of i) non-metastatic, muscle-invasive, and locally advanced UC of the bladder; ii) locally advanced upper tract UC (UTUC); and iii) unresectable locally advanced or metastatic UC (mUC). The panel held multiple meetings to discuss and draft consensus statements using the modified Delphi method. Each drafted statement was anonymously voted on by every panellist. A consensus statement was accepted if ≥ 80% of the panellists chose 'accept completely' or 'accept with some reservation' from the five options, which also included 'accept with major reservation', 'reject with reservation', and 'reject completely'.The panel reached a consensus on 63 statements based on current evidence and expert insights. These statements addressed the considerations for different treatment modalities, including surgical approaches, radiotherapy, radiosensitisers, platinum-based chemotherapy, immune checkpoint inhibitors, and antibody-drug conjugates, in the management of different disease entities, including muscle-invasive UC of the bladder, cN1 disease, locally advanced UTUC, unresectable locally advanced/mUC, and oligometastatic bladder cancer.These consensus statements are anticipated to serve as a practical recommendation for clinicians in Hong Kong, and possibly the Asia-Pacific region, regarding the management of muscleinvasive and advanced UC.