SEOM clinical guideline for treatment of muscle-invasive and metastatic urothelial bladder cancer (2018)

• Aranzazu González del Alba ^[1] ; G. De Velasco ^[7] ; N. Lainez ^[2] ; P. Maroto ^[3] ; R. Morales-Barrera ^[8] ; J. Muñoz-Langa ^[9] ; B. Pérez-Valderrama ^[4] ; L. Basterretxea ^[10] ; C. Caballero ^[5] ; S. Vazquez ^[6]
  1. [1] Hospital Universitario Puerta de Hierro

     Hospital Universitario Puerta de Hierro

     Madrid, España

     
  2. [2] Gobierno de Navarra

     Gobierno de Navarra

     Pamplona, España

     
  3. [3] Hospital de la Santa Creu i Sant Pau

     Hospital de la Santa Creu i Sant Pau

     Barcelona, España

     
  4. [4] Hospital Universitario Virgen del Rocío

     Hospital Universitario Virgen del Rocío

     Sevilla, España

     
  5. [5] Hospital General Universitario de Valencia

     Hospital General Universitario de Valencia

     Valencia, España

     
  6. [6] Hospital Universitario Lucus Augusti

     Hospital Universitario Lucus Augusti

     Lugo, España

     
  7. [7] Hospital Universitario Doce de Octubre
  8. [8] Instituto de Oncologia Vall d’Hebron
  9. [9] Hospital Universitari i Politècnic la Fe
  10. [10] Hospital Donostia

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• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 21, Nº. 1 (January 2019), 2019, págs. 64-74
• Idioma: inglés
• Texto completo no disponible (Saber más ...)
• Resumen

  • 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.