| Oncologist | Line | |||
| First | Second | Third | Subsequent line | |
| 1 | - Gemcitabine plus platinum-based regimen followed by avelumab if platinum-sensitive - PD1/PD-L1 inhibitors ( pembrolizumab or atezolizumab) if platinum ineligible | - PD1/PD-L1 inhibitors if not received in first line - Vinflunine - Anti-FGFR2/3 | - Chemotherapy |
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| 2 | - Gemcitabine plus cisplatin or dd-MVAC for cisplatin-eligible - Gemcitabine plus carboplatin for cisplatin-ineligible | - PD1/PD-L1 inhibitors | - Vinflunine | - EV - Erdafitinib (FGFR3 or 2 alteration) not available in Lebanon |
| 3 | - Platinum-based chemotherapy - PD1/PD-L1 inhibitors for platinum ineligible | - PD1/PD-L1 inhibitors if not received in first line | - BSC | - BSC |
| 4 | - Gemcitabine plus platinum-based regimen | - PD1/PD-L1 inhibitors | - Taxane-based chemotherapy | - MVAC regimen |
| 5 | - Gemcitabine plus platinum-based regimen | - PD1/PD-L1 inhibitors (pembrolizumab, nivolumab, avelumab) | - Vinflunine | - EV |
| 6 | - Gemcitabine plus platinum-based regimen or dd-MVAC | - PD1/PD-L1 inhibitors | - Single agent chemotherapy ( Taxane) | - Non-platinum combination |
| 7 | - Cisplatin-based chemotherapy for cisplatin-eligible patients, followed by avelumab maintenance. - Carboplatin plus gemcitabine for cisplatin-ineligible patients, followed by avelumab maintenance. - Alternatively, if CPS is more than 10% in the cisplatin-ineligible population, first-line pembrolizumab can be considered. | - PD1/PD-L1 inhibitors (pembrolizumab or nivolumab) if the patient did not receive maintenance avelumab - Vinflunine or preferably EV if maintenance avelumab was given, and if available in Lebanon. | - Vinflunine or taxane or FGFR3 inhibitors if they have a mutation by NGS (erdafitinib is not available in Lebanon) |
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| 8 | - Gemcitabine plus carboplatin or cisplatin | - Vinflunine or PD1/PD-L1 inhibitors | - Vinflunine or PD1/PD-L1 inhibitors | - Taxane weekly or anti-FGFR3 if available |
| 9 | - Gemcitabine plus cisplatin | - PD1/PD-L1 inhibitors (Pembrolizumab or nivolumab) | - Taxane | - BSC |
| 10 | - Gemcitabine plus cisplatin - Gemcitabine plus carboplatin (less frequently) - Atezolizumab or pembrolizumab (rarely) | - Pembrolizumab | - Vinflunine | - Taxane |