Canadian Urological Association/Genitourinary Medical Oncologists of Canada consensus statement: Management of unresectable locally advanced and metastatic urothelial carcinoma

In Canada, bladder cancer ranks as the fifth most common cancer, with an estimated 8900 new cases and 2400 deaths in 2018.1 Approximately 15% of patients have locally advanced or metastatic disease at presentation. A further 40–50% of those with muscle-invasive, early-stage disease will relapse after initial treatment. The majority of patients with advanced-stage disease will succumb to their disease. Cancers of the ureter, renal pelvis, and proximal urethra constitute approximately 5–10% of cases of urothelial carcinoma and are treated with similar systemic therapy as bladder cancer. GUMOC (Genitourinary Medical Oncologists of Canada) is comprised of Canadian medical oncologists who specialize in the treatment of genitourinary cancers. With recent advances in systemic therapy, especially due to the emergence of immunotherapy as a therapeutic option, a consensus opinion has become necessary to guide the management of unresectable, locally advanced and metastatic urothelial carcinoma.