OBJECTIVES: Bladder cancer ranks second among urological cancers in France, with an annual incidence of 14,062 new cases and more than 5,335 deaths (Lapôtre-Ledoux 2023). The recurrence and progression rates are high for intermediate/high-risk non-muscle invasive bladder cancer (IR/HR NMIBC) and muscle invasive bladder cancer (MIBC). While alternatives to radical cystectomy (RC) are under development, there are still unmet patient needs especially for BCG unresponsive patients and for those ineligibles for RC. Our objective was to review current literature to specify these unmet needs in France.

METHODS: We carried out a systematic review of the current literature on guidelines, epidemiology, disease burden, and real-life management of IR/HR NMIBC and localized MIBC in a French setting. We included all articles, congress abstracts, and reports from the grey literature, published in English or French, between 2014 and 2024. Identification, screening, and data synthesis were carried out in accordance with PRISMA guidelines, using PubMed and Embase search engines.

RESULTS: We identified a total of 2767 records and included 95 studies. The incidence of NMIBC is systematically underestimated in national reference epidemiological studies, emphasizing the need for better estimates. Adherence to both national and international guidelines is poor, and there is a need for more effective dissemination and implementation. Real-world data on patient’s management is scarce, especially regarding bladder preservation strategies for HR-NMIBC BCG-unresponsive patients. Furthermore, there is limited information available on the characteristics of patients who are ineligible or refuse RC. It is crucial to identify predictive factors that can guide treatment decisions and improve patient outcomes in these cases. Additionally, there is a lack of reliable data on the quality of life, costs and resources use in France.

CONCLUSIONS: Further studies are needed in France to address the data gaps identified here.