SEOM clinical guideline for treatment of muscle-invasive and metastatic urothelial bladder cancer (2018)
Por:
del Alba, A, De Velasco, G, Lainez, N, Maroto, P, Morales-Barrera, R, Munoz-Langa, J, Perez-Valderrama, B, Basterretxea, L, Caballero, C and Vazquez, S
Publicada:
1 ene 2019
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.
Filiaciones:
del Alba, A:
Hosp Univ Puerta Hierro Majadahonda, Med Oncol Dept, Joaquin Rodrigo 2, Madrid 28222, Spain
De Velasco, G:
Hosp Univ Doce Octubre, Med Oncol Dept, Madrid, Spain
Lainez, N:
Complejo Hosp Navarra, Med Oncol Dept, Pamplona, Spain
Maroto, P:
Hosp Santa Creu & Sant Pau, Med Oncol Dept, Barcelona, Spain
Morales-Barrera, R:
Vall dHebron Univ Hosp, Vall dHebron Inst Oncol, Med Oncol Dept, Barcelona, Spain
:
Hosp Univ & Politecn La Fe, Med Oncol Dept, Valencia, Spain
Perez-Valderrama, B:
Hosp Univ Virgen Rocio, Med Oncol Dept, Seville, Spain
Basterretxea, L:
Hosp Donostia Donostia Ospitalea, Med Oncol Dept, Donostia San Sebastian, Spain
Caballero, C:
Hosp Gen Univ Valencia, Ctr Invest Biomed Red Canc, Ciberonc, Med Oncol Dept, Valencia, Spain
Vazquez, S:
Hosp Univ Lucus Augusti, Med Oncol Dept, Lugo, Spain
hybrid, Green Published
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