The European Society for Medical Oncology (ESMO) has issued an e-update to its guidelines on the diagnosis, treatment and follow-up of bladder cancer.
The updated guidelines recommend that pembrolizumab should be considered in patients with platinum-refractory urothelial cancer (UC) as it has been shown to improve overall survival (OS) (level I A recommendation). Level II B evidence from phase 1-4 trials have shown consistent OS signals with atezolizumab, and therefore, it is also recommended in this setting. The use of nivolumab, avelumab and durvalumab is supported by level III B evidence, but ESMO advises that these agents can be used in UC.
ESMO says biomarkers should not be used to select patients for therapy in platinum-refractory UC.
The update states that carboplatin-based chemotherapy, pembrolizumab or atezolizumab are all reasonable choices for patients who are PD-L1 positive and who are not eligible for cisplatin-based chemotherapy. Pembrolizumab and atezolizumab should only be used in patients who are PD-L1 positive [III, B].
Erdafitinib has not yet been approved by the European Medicines Agency. However, ESMO advises that the drug can be considered in pre-treated patients with advanced UC bearing FGFR2/3 alterations [III, B], if available.
The full e-update is available here.