TABLE 4.

First-Line Systemic Therapy in Advanced Metastatic Urothelial Carcinoma in Patients Not Eligible for Chemotherapy With Cisplatin

First-Line Systemic Therapy in Patients Ineligible for Cisplatin Chemotherapy	Agreement, %
The preferred regimen for treating patients ineligible for cisplatin is the combination of gemcitabine and carboplatin.* In case of complete response, partial response, or stable disease, continue maintenance therapy with avelumab until disease progression or unacceptable toxicity. Remarks: *Standard dosage: carboplatin AUC5 day 1, and gemcitabine 1,000 mg/m2 once on days 1 and 8 in cycles of 21 days or once on days 1, 8, and 15 in cycles of 28 days Avelumab maintenance therapy: standard dosage 800 mg IV once on day 1 in 14-day cycles	100
Pembrolizumab alone is a first-line option for platin-ineligible patients whose tumors express PD-L1. Remarks: *Standard dosage for pembrolizumab: 2 mg/kg to a maximum of 200mg IV once per day in 21-day cycles or fixed dose: 200 mg once every 3 weeks or 400 mg once every 6 weeks	80
Pembrolizumab alone is an option in patients who are not eligible for platinum chemotherapy regardless of PD-L1 expression, especially in patients without other treatment options. Remarks: *Standard dosage for pembrolizumab: 2 mg/kg to a maximum of 200mg IV once per day in 21-day cycles or fixed dose: 200 mg once every 3 weeks or 400 mg once every 6 week	60
Highly selected patients with oligometastatic disease who do not have evidence of rapid progression may benefit from metastasectomy or local ablative therapy after response to systemic therapy.	100

Abbreviation: IV, intravenous route.