RT Book, Section
A1 Andreev-Drakhlin, Alexander Y.
A1 Kamat, Ashish M.
A1 Siefker-Radtke, Arlene O.
A2 Kantarjian, Hagop M.
A2 Wolff, Robert A.
A2 Rieber, Alyssa G.
SR Print(0)
ID 1190837670
T1 Bladder Cancer
T2 The MD Anderson Manual of Medical Oncology, 4e
YR 2022
FD 2022
PB McGraw Hill Education
PP New York, NY
SN 9781260467642
LK accessmedicine.mhmedical.com/content.aspx?aid=1190837670
RD 2024/04/16
AB KEY  CONCEPTSPembrolizumab  has  recently  been  approved  for  patients  with  Bacillus  Calmette-Guerin  (BCG)-unresponsive  non–muscle-invasive  urothelial  cancer  based  on  responses  observed  in  a  cohort  of  patients  with  carcinoma  in  situ  in  their  bladders.Neoadjuvant  cisplatin-based  chemotherapy  remains  the  standard  of  care  treatment  for  muscle-invasive  bladder  cancer.  Dose-dense  MVAC  (methotrexate,  vinblastine,  doxorubicin,  and  cisplatin)  has  largely  supplanted  traditional  MVAC  because  of  its  improved  toxicity  profile  and  shorter  time  to  surgery.Immune  checkpoint  inhibitors  have  been  approved  frontline  treatment  for  patients  with  metastatic  urothelial  cancer  who  are  not  eligible  for  cisplatin-based  chemotherapy.  Programmed  cell  death  ligand  1  (PD-L1)  expression  is  required  in  this  setting.Immune  checkpoint  inhibitors  are  also  approved  after  chemotherapy  with  level  1  evidence  showing  a  survival  benefit  with  pembrolizumab  in  the  second-line  setting  and  with  avelumab  in  the  maintenance  setting  in  patients  with  stable  disease  or  better  for  frontline  chemotherapy.  At  the  moment,  there  is  no  definitive  evidence  as  to  whether  maintenance  checkpoint  inhibition  or  checkpoint  inhibition  at  progression  is  the  optimal  treatment  strategy.  PD-L1  expression  is  not  needed  in  the  postchemotherapy  setting.In  April  2019,  the  Food  and  Drug  Administration  (FDA)  granted  accelerated  approval  to  erdafitinib,  the  first-in-class  fibroblast  growth  factor  receptor  3  (FGFR3)  inhibitor  based  on  efficacy  in  the  second-line  setting.  FGFR3  mutations  or  fusions  are  required  for  treatment.In  December  2019,  the  FDA  granted  accelerated  approval  to  enfortumab  vedotin,  the  first  antibody–drug  conjugate  approved  for  urothelial  cancer  based  on  efficacy  in  the  third-line  setting  (postchemotherapy,  postimmunotherapy).  This  antibody  targets  nectin-4,  which  is  highly  expressed  in  urothelial  cancer,  so  expression  levels  are  not  necessary.