- The European Society for Medical Oncology (ESMO) has issued an update to its 2014 guidelines for the treatment of bladder cancer.
- The update focuses on the role of immune checkpoint inhibitors and targeted therapy in the management of advanced and metastatic disease.
- Immune checkpoint inhibition in platinum-refractory disease:
- Pembrolizumab is recommended based on OS improvement in KEYNOTE-045 study (evidence level: I, recommendation grade: A).
- Atezolizumab has shown consistent positive OS signals in an intent-to-treat population in IMvigor211 and the real-world SAUL study (II, B).
- Nivolumab can be considered based on OS benefit seen in CHECKMATE 275 (III, B).
- Avelumab and durvalumab can also be considered (III C; not approved by the European Medicines Agency as of August 22, 2019).
- Cisplatin-ineligible front-line programmed death-ligand 1 (PD-L1) biomarker-positive metastatic urothelial cancer:
- Pembrolizumab or atezolizumab can be considered first-line treatment in patients with PD-L1-positive disease (III, B).
- Erdafitinib and enfortumab vedotin in platinum-refractory urothelial cancer: