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- Document type:
- Article; Early Access
- Author(s):
- von Amsberg, Gunhild; Retz, Margitta; De Santis, Maria; Niegisch, Gunter
- Title:
- First-line treatment of metastatic urothelial carcinoma: an update
- Abstract:
- Background Urothelial carcinoma (UC) of the bladder is considered to be a tumor sensitive to chemotherapy. Nevertheless, the 5-year survival rate in stage IV is < 5%. Approximately half of the patients receive only first-line treatment due to rapid disease progression and/or poor general condition. Objective Narrative review of the first-line treatment of advanced UC. Material and methods Evaluation of treatment recommendations of national and international guidelines as well as a literature search in PubMed and congress abstracts. Results Crucial for the choice of first-line treatment is the (cis)platinum eligibility. If possible, a chemotherapy combination containing cisplatin should be carried out. In cases of contraindications, cisplatin can be replaced by carboplatin but at the cost of a loss of efficacy. If at least stable disease is achieved after 4-6 cycles of treatment containing platinum, immune maintenance therapy with avelumab should be subsequently applied. The programmed cell death 1 ligand 1 (PD-L1) inhibitor showed a survival benefit compared with best supportive care (BSC) regardless of prior platinum treatment or cycle number. Patients with (cis)platinum ineligibility and positive PD-L1 status can receive immuno-monotherapy with atezolizumab or pembrolizumab. For the remaining patients, an individual decision has to be made whether and which systemic treatment should be considered or whether a BSC approach should be favored. Conclusion The course of the disease is set early, before initiation of first-line treatment, with the determination of (cis)platinum eligibility. Avelumab is the first immune maintenance treatment available with significant survival benefit.
- Journal title abbreviation:
- Onkologie
- Year:
- 2022
- Fulltext / DOI:
- doi:10.1007/s00761-022-01217-5
- Print-ISSN:
- 0378-584X
- TUM Institution:
- Klinik und Poliklinik für Urologie
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