What are protocols for second-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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Answer

Answer

There are no definitive recommendations for second-line therapy. Potential options for palliative therapy depends on the chemotherapy that was used for first-line treatment. Chemotherapy options may include drugs such as cisplatin, gemcitabine, pemetrexed, carboplatin, vinblastine, and bleomycin, which have shown some beneficial effects in various trials [1] :

  • Atezolizumab 1200 mg IV q3wk infused over 60 min until disease progression or unacceptable toxicity [18]
  • Nivolumab 240 mg IV q2wk or 480 mg q4wk over 30 min until disease progression or unacceptable toxicity [19]
  • Avelumab 10 mg/kg IV q2wk infused over 60 min until disease progression or unacceptable toxicity [20]
  • Pembrolizumab 200 IV q3wk infused over 30 min until disease progression or unacceptable toxicity, or up to 24 months in patients without disease progression [21]
  • Erdafitinib 8 mg PO qd initially; increase to 9 mg PO qd based on serum phosphate levels and tolerability at 14-21 days; for metastatic urothelial carcinoma that has FGFR2 or FGFR3 genetic alterations and that progressed during or following at least 1 line of prior platinum-containing chemotherapy [23]

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