SEOM clinical guideline for treatment of muscle-invasive and metastatic urothelial bladder cancer (2018).
A González Del AlbaG De VelascoN LainezP MarotoR Morales-BarreraJ Muñoz-LangaB Pérez-ValderramaL BasterretxeaC CaballeroS VazquezPublished in: Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico (2018)
The goal of this article is to provide recommendations about the management of muscle-invasive (MIBC) and metastatic bladder cancer. New molecular subtypes of MIBC are associated with specific clinical-pathological characteristics. Radical cystectomy and lymph node dissection are the gold standard for treatment and neoadjuvant chemotherapy with a cisplatin-based combination should be recommended in fit patients. The role of adjuvant chemotherapy in MIBC remains controversial; its use must be considered in patients with high-risk who are able to tolerate a cisplatin-based regimen, and have not received neoadjuvant chemotherapy. Bladder-preserving approaches are reasonable alternatives to cystectomy in selected patients for whom cystectomy is not contemplated either for clinical or personal reasons. Cisplatin-based combination chemotherapy is the standard first-line protocol for metastatic disease. In the case of unfit patients, carboplatin-gemcitabine should be considered the preferred first-line chemotherapy treatment option, while pembrolizumab and atezolizumab can be contemplated for individuals with high PD-L1 expression. In cases of progression after platinum-based therapy, PD-1/PD-L1 inhibitors are standard alternatives. Vinflunine is another option when anti-PD-1/PD-L1 therapy is not possible. There are no data from randomized clinical trials regarding moving on to immuno-oncology agents.
Keyphrases
- neoadjuvant chemotherapy
- locally advanced
- end stage renal disease
- squamous cell carcinoma
- ejection fraction
- lymph node
- chronic kidney disease
- prognostic factors
- sentinel lymph node
- clinical trial
- rectal cancer
- skeletal muscle
- radiation therapy
- palliative care
- spinal cord injury
- patient reported outcomes
- combination therapy
- single molecule
- clinical practice
- electronic health record
- early stage
- minimally invasive
- smoking cessation
- patient reported
- high grade
- study protocol