Current Treatment Options for Metastatic Urothelial Cancer

Jonathan E. Rosenberg, MD, chief of Genitourinary Oncology Service, Division of Solid Tumor Oncology at Memorial Sloan Kettering Cancer Center, discusses what the frontline treatment landscape for metastatic urothelial cancer currently looks like.

According to Rosenberg, patients who are cisplatin eligible, experts recommend a cisplatin-based combination chemotherapy of either gemcitabine and cisplatin, or dose-dense MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin). Cisplatin ineligible patients are likely to be given gemcitabine and carboplatin, then maintenance nivolumab (Opdivo).

A treatment option for patients not eligible for any platinum chemotherapy, or for those with multiple comorbidities, is checkpoint inhibitor monotherapy with either atezolizumab (Tecentriq) or pembrolizumab (Keytruda).

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0:08 | Today, there are several treatment options for patients with metastatic urothelial cancer who have not yet received prior therapy. For patients who are cisplatin candidates, cisplatin-based combination chemotherapy is the standard. Either gemcitabine and cisplatin or dose-dense MVAC are the 2 options.

0:23 | For patients who are cisplatin ineligible, gemcitabine and carboplatin followed by maintenance nivolumab, if they respond, is the most common option for PD-L1–positive patients in the United States. Atezolizumab is an option as well.

0:38 | For those patients who are not eligible for any platinum chemotherapy or people who have multiple comorbidities, checkpoint inhibitor monotherapy with either atezolizumab or pembrolizumab are both possible treatment choices for those patients