Table 2.
NCCN | EAU | |
---|---|---|
Indications for neoadjuvant chemotherapy | cT2 or cT3 (strongly consider) disease | cT2 or cT3 disease |
Indications for adjuvant chemotherapy | Consider for pT3-4 disease or positive nodes, if no neoadjuvant therapy was given | Not indicated after cystectomy. Should be given in a clinical trial setting. Should not be given to patients who cannot tolerate cisplatin |
Indications for up-front chemotherapy | Clinically positive nodes, cT4, and metastatic disease | Clinically positive nodes, cT4, and metastatic disease |
First-line regimens | GC (preferred), MVAC | GC, MVAC (preferably with GCSF), or DD-MVAC with GCSF |
Patients unfit for cisplatin | If renal function is borderline or minimal dysfunction, consider a split dose administration (ie, 35 mg/m2 on days 1 and 2 or days 1 and 8). Otherwise consider carboplatin and taxane-based regimens as alternative first-line regimens or single-agent therapy |
Carboplatin-containing combination chemotherapy, preferably with gemcitabine-carboplatin as first-line treatment |
Second-line agents | No standard, but patients should seek participation of a clinical trial at this juncture | Vinflunine (approved in Europe) or participation in a clinical trial. Zoledronic acid or denosumab are recommended for bone metastasis |
Abbreviations: NCCN, National Comprehensive Cancer Network; EAU, European Association of Urology; GC, gemcitabine + cisplatin; MVAC, methotrexate + vinblastine + doxorubicin (Adriamycin) + cisplatin; GCSF, granulocyte colony stimulating factor; DD, dose-dense.