Info

🌱 來自: bladder cancer

management of metastatic disease-of-bladder cancer

• 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 of bladder cancer
  • (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 of metastatic disease-of-bladder cancer
• 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