The 2021 Updated European Association of Urology Guidelines on Metastatic Urothelial Carcinoma

Richard Cathomas; Anja Lorch; Harman M Bruins; Eva M Compérat; Nigel C Cowan; Jason A Efstathiou; Rainer Fietkau; Georgios Gakis; Virginia Hernández; Estefania Linares Espinós; Yann Neuzillet; Maria J Ribal; Matthieu Rouanne; George N Thalmann; Antoine G van der Heijden; Erik Veskimäe; J Alfred Witjes; Matthew I Milowsky; EAU Muscle-invasive, Metastatic Bladder Cancer Guidelines Panel

doi:10.1016/j.eururo.2021.09.026

The 2021 Updated European Association of Urology Guidelines on Metastatic Urothelial Carcinoma

Eur Urol. 2022 Jan;81(1):95-103. doi: 10.1016/j.eururo.2021.09.026. Epub 2021 Nov 3.

Authors

Richard Cathomas¹, Anja Lorch², Harman M Bruins³, Eva M Compérat⁴, Nigel C Cowan⁵, Jason A Efstathiou⁶, Rainer Fietkau⁷, Georgios Gakis⁸, Virginia Hernández⁹, Estefania Linares Espinós¹⁰, Yann Neuzillet¹¹, Maria J Ribal¹², Matthieu Rouanne¹¹, George N Thalmann¹³, Antoine G van der Heijden¹⁴, Erik Veskimäe¹⁵, J Alfred Witjes¹⁴, Matthew I Milowsky¹⁶; EAU Muscle-invasive, Metastatic Bladder Cancer Guidelines Panel

Affiliations

¹ Division of Oncology/Hematology, Cantonal Hospital Grisons, Chur, Switzerland. Electronic address: richard.cathomas@ksgr.ch.
² Department of Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland.
³ Department of Urology, Zuyderland Medical Center, Sittard-Geleen-Heerlen, the Netherlands.
⁴ Department of Pathology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Hopital Tenon, Paris, France.
⁵ Department of Radiology, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK.
⁶ Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA.
⁷ Department of Radiation Therapy, University of Erlangen, Erlangen, Germany.
⁸ Department of Urology and Pediatric Urology, University of Würzburg, Würzburg, Germany.
⁹ Department of Urology, Hospital Universitario Fundación Alcorcón, Madrid, Spain.
¹⁰ Department of Urology, Hospital Universitario La Paz, Madrid, Spain.
¹¹ Department of Urology, Foch Hospital, University of Versailles-Saint-Quentin-en-Yvelines, Université Paris-Saclay, Suresnes, France.
¹² Department of Urology, Hospital Clinic, University of Barcelona, Barcelona, Spain.
¹³ Department of Urology, Inselspital, University Hospital Bern, Bern, Switzerland.
¹⁴ Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
¹⁵ Department of Urology, Tampere University Hospital, Tampere, Finland.
¹⁶ Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.

PMID: 34742583
DOI: 10.1016/j.eururo.2021.09.026

Abstract

Context: Treatment of metastatic urothelial carcinoma is currently undergoing a rapid evolution.

Objective: This overview presents the updated European Association of Urology (EAU) guidelines for metastatic urothelial carcinoma.

Evidence acquisition: A comprehensive scoping exercise covering the topic of metastatic urothelial carcinoma is performed annually by the Guidelines Panel. Databases covered by the search included Medline, EMBASE, and the Cochrane Libraries, resulting in yearly guideline updates.

Evidence synthesis: Platinum-based chemotherapy is the recommended first-line standard therapy for all patients fit to receive either cisplatin or carboplatin. Patients positive for programmed death ligand 1 (PD-L1) and ineligible for cisplatin may receive immunotherapy (atezolizumab or pembrolizumab). In case of nonprogressive disease on platinum-based chemotherapy, subsequent maintenance immunotherapy (avelumab) is recommended. For patients without maintenance therapy, the recommended second-line regimen is immunotherapy (pembrolizumab). Later-line treatment has undergone recent advances: the antibody-drug conjugate enfortumab vedotin demonstrated improved overall survival and the fibroblast growth factor receptor (FGFR) inhibitor erdafitinib appears active in case of FGFR3 alterations.

Conclusions: This 2021 update of the EAU guideline provides detailed and contemporary information on the treatment of metastatic urothelial carcinoma for incorporation into clinical practice.

Patient summary: In recent years, several new treatment options have been introduced for patients with metastatic urothelial cancer (including bladder cancer and cancer of the upper urinary tract and urethra). These include immunotherapy and targeted treatments. This updated guideline informs clinicians and patients about optimal tailoring of treatment of affected patients.

Keywords: Bladder cancer; European Association of Urology; Guidelines; Immunotherapy; Metastatic; Systemic therapy; Urothelial carcinoma.

Publication types

Review

MeSH terms

Carcinoma, Transitional Cell* / drug therapy
Carcinoma, Transitional Cell* / pathology
Cisplatin
Female
Humans
Male
Urinary Bladder Neoplasms* / drug therapy
Urinary Bladder Neoplasms* / pathology
Urology*

Substances

Cisplatin