%0 Journal Article
%A González Del Alba, A
%A De Velasco, G
%A Lainez, N
%A Maroto, P
%A Morales-Barrera, R
%A Muñoz-Langa, J
%A Pérez-Valderrama, B
%A Basterretxea, L
%A Caballero, C
%A Vazquez, S
%T SEOM clinical guideline for treatment of muscle-invasive and metastatic urothelial bladder cancer (2018).
%D 2018
%U http://hdl.handle.net/10668/13329
%X The goal of this article is to provide recommendations about the management of muscle-invasive (MIBC) and metastatic bladder cancer. New molecular subtypes of MIBC are associated with specific clinical-pathological characteristics. Radical cystectomy and lymph node dissection are the gold standard for treatment and neoadjuvant chemotherapy with a cisplatin-based combination should be recommended in fit patients. The role of adjuvant chemotherapy in MIBC remains controversial; its use must be considered in patients with high-risk who are able to tolerate a cisplatin-based regimen, and have not received neoadjuvant chemotherapy. Bladder-preserving approaches are reasonable alternatives to cystectomy in selected patients for whom cystectomy is not contemplated either for clinical or personal reasons. Cisplatin-based combination chemotherapy is the standard first-line protocol for metastatic disease. In the case of unfit patients, carboplatin-gemcitabine should be considered the preferred first-line chemotherapy treatment option, while pembrolizumab and atezolizumab can be contemplated for individuals with high PD-L1 expression. In cases of progression after platinum-based therapy, PD-1/PD-L1 inhibitors are standard alternatives. Vinflunine is another option when anti-PD-1/PD-L1 therapy is not possible. There are no data from randomized clinical trials regarding moving on to immuno-oncology agents.
%K Bladder cancer
%K Chemotherapy
%K Cystectomy
%K Immune checkpoint inhibitors
%~