Info

🌱來自: urothelial carcinoma

Management Metastatic UC

Cisplatin-based chemo is the preferred initial tx (ddMVAC, GC), if eligible 1st line: GC preferred over MVAC d/t equal efficacy w/ less toxicity (less neutropenia, neutropenic sepsis, mucositis) (JCO 2000:18:3068). ddMVAC (q2wk w/ GCSF support) has ↑ RR, ↓ toxicity compared to MVAC (JCO 2001;19:2638) If cisplatin ineligible (CrCl ≤60 mL/min; ECOG PS ≥2; Grade 2 hearing loss/neuropathy; NYHA HF class ≥3) but platinum eligible: Use gemcitabine + carboplatin (JCO 2012;30:191) OR if PD-L1 positive: Pembrolizumab (Lancet Onc 2017;18:1483) or atezolizumab (Lancet 2017;389:67) If platinum ineligible (CrCl <30 mL/min; ECOG PS >3; neuropathy grade >3; NYHA HF Class >3; ECOG PS 2 & CrCl <30 mL/min): Pembrolizumab or atezolizumab Maintenance avelumab ↑ OS after partial response or stable dz to platinum (NEJM 2020;383:1218) 2nd line: FDA-approved agents include pembrolizumab a/w ↑ OS vs. chemo (NEJM 2017;376:1015), nivolumab a/w 24% RR (Lancet Onc 2016;17:1590), avelumab a/w 17% RR (Lancet Onc 2018;19:51). If FGFR2/3 genetic alterations, erdafitinib can be used post platinum, a/w 40% RR (NEJM 2019;381:338), but usually deferred until 3rd or 4th line 3rd line: Enfortumab vedotin a/w ↑ OS vs. chemo post platinum & PD-1/L1 inhibitor (NEJM 2021;384:1125); Sacituzumab govitecan a/w RR 27% (JCO 2021;39(22):2474) Can consider gemcitabine, docetaxel, paclitaxel monotherapy in later tx lines

• ddMVAC

Siblings

• Epidemiology-of-urothelial carcinoma
• Etiology and clinical manifestations-of-urothelial carcinoma
• Pathologic Subtypes-of-urothelial carcinoma
• Workup-of-urothelial carcinoma
• Staging and prognosis-of-urothelial carcinoma
• Management of Nonmuscle invasive UC
• Management of Muscle invasive UC
• Management Metastatic UC
• Cancers of the renal pelvis and ureter
• Molecular biology and targeted therapy-of-urothelial carcinoma