What are EAU recommendations the treatment of metastatic bladder cancer?

Updated: Feb 23, 2021
  • Author: Kara N Babaian, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

According to the EAU, first-line treatment for cisplatin-eligible patients is with one of the following cisplatin-containing combination chemotherapy regimens [144] :

  • GC (gemcitabine plus cisplatin)
  • MVAC (methotrexate, vinblastine, Adriamycin [doxorubicin], cisplatin), preferably with granulocyte colony-stimulating factor (G-CSF)
  • HD-MVAC (high-dose methotrexate, vinblastine, doxorubicin, cisplatin) with G-CSF
  • PCG (paclitaxel, cisplatin, gemcitabine)

Do not offer carboplatin and non-platinum combination chemotherapy.

First-line treatment in patients ineligible (unfit) for cisplatin whose tumors are programmed death ligand 1 (PD-L1)–positive is with the checkpoint inhibitors pembrolizumab or atezolizumab. Offer carboplatin combination chemotherapy if PD-L1 is negative.

Other recommendations are as follows:

  • Offer pembrolizumab to patients who experience progression during or after platinum-based combination chemotherapy for metastatic disease. Alternatively, offer treatment within a clinical trial setting.
  • Offer zoledronic acid or denosumab for supportive treatment in case of bone metastases.
  • Offer vinflunine as subsequent-line treatment only if immunotherapy, combination chemotherapy, fibroblast growth factor receptor 3 (FGFR3) inhibitor therapy, or inclusion in a clinical trial is not feasible.

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