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Clin Transl Oncol. 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).

Author information

1
Medical Oncology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Joaquin Rodrigo 2, 28222, Majadahonda, Madrid, Spain. aranzazu.gonzalezalba@salud.madrid.org.
2
Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain.
3
Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain.
4
Medical Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
5
Medical Oncology Department, Vall d'Hebron Institute of Oncology, Vall d' Hebron University Hospital, Barcelona, Spain.
6
Medical Oncology Department, Hospital Universitari I Politècnic la Fe, Valencia, Spain.
7
Medical Oncology Department, Hospital Universitario Virgen del Rocio, Sevilla, Spain.
8
Medical Oncology Department, Hospital Donostia-Donostia Ospitalea, Donostia, Spain.
9
Medical Oncology Department, Ciberonc, Centro de Investigación Biomédica en Red Cáncer. Hospital General Universitario de Valencia, Valencia, Spain.
10
Medical Oncology Department, Hospital Universitario Lucus Augusti, Lugo, Spain.

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

PMID:
30565086
PMCID:
PMC6339669
DOI:
10.1007/s12094-018-02001-x
[Indexed for MEDLINE]
Free PMC Article

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