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379EXPERT REPORTCUAJ %u2022 DECEMBER 2024 %u2022 VOLUME 18, ISSUE 12 %u00a9 2024 CANADIAN UROLOGICAL ASSOCIATION 379INTRODUCTIONUrothelial cancer (UC) ranks as the fifth most common cancer in Canada, with an estimated 13 400 new cases and 2600 deaths in 2023.1 Although these cancers can develop anywhere along the urinary tract, they most commonly arise from the urinary bladder. At diagnosis, 70% of patients will have non-muscle invasive disease (NMIBC), 25% muscle-invasive disease (MIBC), and 5% will have incurable locally advanced (LA) or metastatic UC (mUC). Treatment outcomes for UC remain suboptimal, with up to 40%u201350% of patients with MIBC relapsing despite definitive treatment, and real-world contemporary evidence suggesting a median overall survival (mOS) of only 20 months (mos) for patients with mUC.2-5Since the 2019 publication of the previous Genitourinary Medical Oncologists of Canada (GUMOC) consensus statement on the management of mUC,6 the field has witnessed significant therapeutic advances, marked by the introduction of several new treatment modalities, including immunotherapy (IO), novel antibody drug conjugates (ADC), and targeted therapies. This updated Expert Report aims to incorporate recent data from randomized controlled trials (RCTs) into evidence-based recommendations to guide management of patients with mUC in Canada. METHODSWe 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). Statements pertaining to aspects of management are intended to provide general guidance regarding treatment decision making, however, are not meant to supersede clinical judgement of individual scenarios. Carlos E. Stecca*1, Deepro Chowdhury*1, Normand Blais2, Nimira Alimohamed3, Lori Wood4, Christina M. Canil5, Bernie Eigl6, Girish S. Kulkarni7, Peter C. Black8, Wassim Kassouf9, Peter Chung10, Scott North11, Di Maria Jiang1, Srikala S. Sridhar11Division of Hematology and Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada; 2Division of Medical Oncology/Hematology, Centre Hospitalier de l%u2019 Universit%u00e9 de Montr%u00e9al, Montreal, QC, Canada; 3Department of Medicine, Division of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada; 4Division of Medical Oncology, QEII Health Sciences Center, Halifax, NS, Canada; 5The Ottawa Hospital Cancer Center, Ottawa, ON Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; 6BC Cancer, Vancouver, BC, Canada; 7Divisions of Urology and Surgical Oncology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada; 8Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada; 9Department of Surgery, McGill University Health Center, Montreal, QC, Canada; 10Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; 11Department of Medical Oncology, Cross Cancer Institute, Edmonton, AB, Canada*Co-first authorsREVIEWERS:Dominick Boss%u00e9, Ottawa Cancer Centre, Ottawa, ON, CanadaRodney H. Breau, University of Ottawa, Ottawa, ON, CanadaHenry Conter, London Regional Cancer Program, London, ON, CanadaCite as: Stecca CE, Chowdhury D, Blais N, et al. 2024 CUA-GUMOC Expert Report: Management of unresectable locally advanced and metastatic urothelial carcinoma. Can Urol Assoc J2024;18(12):379-90. http://dx.doi.org/10.5489/cuaj.8946See related commentary on page 3912024 CUA-GUMOC Expert Report: Management of unresectable locally advanced and metastatic urothelial carcinoma