What are protocols for first-line chemotherapy in muscle-invasive bladder cancer?

Updated: Feb 23, 2021
  • Author: Gary David Steinberg, MD, FACS; Chief Editor: E Jason Abel, MD  more...
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Drugs currently used in the management of advanced bladder cancer include combinations of gemcitabine and cisplatin: Gemcitabine 1000 mg/m2 on days 1, 8, and 15 plus  cisplatin 70 mg/m2 IV on day 1 or 2; repeat cycle every 28 d for a total of four cycles.

Other drug regimens include combinations of methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC): Methotrexate 30 mg/m2 IV on days 1, 15, and 22 plus  vinblastine 3 mg/m2 IV on days 2, 15, and 22 plus  doxorubicin 30 mg/m2 IV on Day 2 plus  cisplatin 70 mg/m2 IV on day 2; repeat cycle every 28d for a total of 3 cycles.

The FDA granted accelerated approval of atezolizumab, the first cancer immunotherapy that acts as a programmed cell death ligand inhibitor (PD-L1), as first-line treatment for locally advanced or metastatic urothelial carcinoma in patients who are not eligible for cisplatin-containing chemotherapy. [16]

Atezolizumab 1200 mg IV q3wk infused over 60 min until disease progression or unacceptable toxicity

Pembrolizumab 200 IV q3wk infused over 30 min until disease progression or unacceptable toxicity, or up to 24 months in patients without disease progression [17]

"Dose-dense" regimens for MVAC and GemCis, in which increased doses are administered along with doses of growth factor stimulants (eg, GM-CSF), have shown similar efficacy as conventional regimens

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