Treatment option | Clinical baseline characteristics |
Combination chemotherapy (cisplatin-based chemotherapy/gemcitabine + carboplatin) | · For cisplatin-based chemotherapy, the patient has to have: o A good ECOG performance status o Good renal function (creatinine clearance: >60 mL/minute) o Good cardiac function · For carboplatin-based chemotherapy, the experts often give it to patients with poor performance status, renal failure so as to adjust according to GFR as well as those with compromised cardiac function. · Other factors to consider are age, hematologic and hepatic functions, neuropathy, and hearing status. |
Pembrolizumab | · ECOG performance status · Unfit patient · Renal function impairment · Cardiac failure · MSI-H tumors · PD-L1 positivity in first line · Platinum ineligibility · Autoimmune conditions · In all patients in second line if not used in first line for advanced setting or after failure of first-line platinum-based chemotherapy · In the first-line setting in patients who are cisplatin-ineligible |
Atezolizumab | · ECOG performance status · Unfit patient · Renal function impairment · Cardiac failure · PD-L1 status in first line · PD-L1 positivity in first line · Platinum ineligibility · Autoimmune conditions · In all patients in second line if not used in first line for advanced setting · In the first-line setting in patients who are cisplatin-ineligible |
Nivolumab | · ECOG performance status · Platinum ineligibility · Autoimmune conditions · In the adjuvant patient in patients who received or not neoadjuvant chemotherapy; all comers can benefit from this treatment · In the second-line setting after failure of first-line chemotherapy regimen whether cisplatin or carboplatin Not recommended as first-line option but in subsequent lines in case of resistance to platinum. One expert reported not using nivolumab for the treatment of locally advanced/metastatic UC patients. |
The FGFR inhibitor erdafitinib | · In second- or third-line patients harboring FGFR2 and 3 genetic alterations · Creatinine clearance · Resistance to first-line platinum with NGS that showed expression of FGFR or amplification |
Avelumab in maintenance | · In patients who received chemotherapy platinum-based chemotherapy for advanced setting provided they have no underlying autoimmune disease that precludes the use of immune checkpoint inhibitors · Objective response or stable disease following first-line platinum-based therapy · Response to the Javelin 100 chemotherapy scheme · Autoimmune conditions · Platinum ineligibility |