ESMO updates bladder cancer guidelines

  • European Society for Medical Oncology
  • 22 Aug 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • 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.

Key updates

  • 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:
    • Erdafitinib can be considered in pretreated patients with FGFR2/3 alterations (III, B).
    • Enfortumab vedotin can be considered in patients refractory to platinum chemotherapy and antiprogrammed cell death protein 1/anti-PD-L1 therapy (III, B).