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. 2019 Jan;21(1):64-74.
doi: 10.1007/s12094-018-02001-x. Epub 2018 Dec 18.

SEOM Clinical Guideline for Treatment of Muscle-Invasive and Metastatic Urothelial Bladder Cancer (2018)

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Free PMC article

SEOM Clinical Guideline for Treatment of Muscle-Invasive and Metastatic Urothelial Bladder Cancer (2018)

A González Del Alba et al. Clin Transl Oncol. .
Free PMC article

Abstract

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.

Keywords: Bladder cancer; Chemotherapy; Cystectomy; Immune checkpoint inhibitors.

Conflict of interest statement

Conflict of interest

AG reports Advisory Board, consultancy and speaker honoraria/travel support from Pierre Fabre, Roche, Bristol-Myers Squibb, MSD, Pfizer, Novartis, Bayer, Janssen, Sanofi Astellas, EUSA pharma and EISAI, outside the submitted work. Research funding from Astellas. GDV reports advisory board, consultancy, speaker honoraria and travel support from Pierre Fabre, Roche, Bristol-Myers Squibb, Pfizer, Ipsen, Novartis, Bayer, Astellas, EUSA pharma and Eisai, outside the submitted work. Research funding from Roche, Pierre Fabre, Ipsen and Pfizer. NL reports personal fees from Pfizer, Sanofi, Pierre Fabre, Roche, Ipsen, PharmaMar, BMS, Bayer, Astra Zeneca, Astellas, MSD, outside the submitted work. PM reports Advisory Board from Roche. RM reports speaker honoraria or travel support from Bayer, Roche, Astellas, Janssen-Cilag, MSD and Sanofi-Aventis. JML has nothing to disclose. BPV reports honoraria from Pierre Fabre, Astellas Pharma, Novartis, Bristol-Myers Squibb and Ipsen. Consulting or advisory role from Astellas Pharma, Novartis, Pfizer, Pierre Fabre, Bayer, Sanofi, Bristol-Myers Squibb, Roche and Ipsen. Travel, accommodations and expenses from Janssen-Cilag and Bristol-Myers Squibb. LB reports personal fees from Roche, MSD, Bristol-Myers Squibb, outside the submitted work. CC Reports advisory Board, consultancy, speaker honoraria and travel support from Pierre Fabre, Roche, Bristol-Myers Squibb, MSD, Pfizer, Novartis, Bayer, Janssen, Sanofi, Astrazeneca, Tesaro and Ipsen, outside the submitted work. SV reports advisory Board, consultancy and speaker honoraria from Pierre Fabre, Roche, Bristol-Myers Squibb, MSD, Pfizer, Novartis, Bayer, Janssen, Sanofi, Astellas, EUSA pharma and EISAI, outside the submitted work.

Ethical approval

The current study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Not applicable.

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