Page 7 - Management of Advanced Urothelial Carcinoma: Emerging Therapies and Biomarkers

Treatment Overview: MIBC

Muscle-Invasive Bladder Cancer : Stage II-IIIA 1

• Neoadjuvant cisplatin-based combination chemotherapy followed by radical cystectomy
(cT2-T4a N0M0) with urinary diversion and lymph node dissection
*
• Chemoradiotherapy may be offered as an alternative to cystectomy in appropriately selected patients
with MIBC

• Adjuvant cisplatin-based chemotherapy may be offered to high-risk patients who have not received
neoadjuvant therapy

Muscle-Invasive Bladder Cancer : Stage IIIB-IVB 2

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• Patients with surgically unresectable or metastatic disease should be treated with front line combination
systemic chemotherapy or immunotherapy if cisplatin-ineligible

• Patients progressing after front line systemic therapy may be treated with immunotherapy (checkpoint
inhibitors), targeted therapy (when mutation is confirmed), single agent chemotherapy, enrolled in a
clinical trial if eligible, or in the near future, immunoconjugate therapy
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• GURC management algorithm incorporates new therapies as well as required biomarker testing

*Neoadjuvant chemotherapy is not recommended in pts ineligible for cisplatin-based combination chemotherapy, unless goal is downstaging surgically unresectable tumours.

1. Milowsky MI, et al. J Clin Oncol. 2016;34:1945–1952; 2. ASCO. https://www.cancer.net/cancer-types/bladder-cancer/treatments-stage. Accessed December 2018.