Page 10 - Management of Advanced Urothelial Carcinoma: Emerging Therapies and Biomarkers

Management Algorithm (1/3)

Transurethral resection

Very high-risk or Muscle-invasive bladder cancer
BCG-refractory disease
Neoadjuvant chemotherapy + Trimodality therapy

Poor response Good response

Radical cystectomy Fit for
cystectomy
Pathologic evaluation

Adverse pathological
Reflex testing features * LOCALLY ADVANCED
UROTHELIAL
PD-L1 IHC
CARCINOMA
Adjuvant (See next slide for
chemotherapy management)
(if chemo naïve)

Follow up imaging and lab studies for
5 years †

* Adverse pathologic features include lymph node metastases, lymphovascular invasion, positive surgical margins, pathologic T3/T4, consider for patients T2; + If patients are fit for cisplatin-based NAC; BCG,
Bacillus Calmette-Guerin; PD-L1, programmed death ligand 1; MIBC, muscle invasive bladder cancer; NAC, neoadjuvant chemotherapy;
† Follow up imaging & lab studies at 3, 6, 12, 18, 24, 36, 48 and 60 months. Imaging modalities, frequency is dependent upon pathological stage