Table 2.

Guideline recommendations for systemic chemotherapy for urothelial carcinoma of the bladder14,37

	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.