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. 2021 Jul 15;9(7):e002552. doi: 10.1136/jitc-2021-002552

Table 5.

mUC treatment algorithm

Patient population Management
Cisplatin-eligible Platinum-based chemotherapy If no disease progression Avelumab maintenance
If disease progression Pembrolizumab
Avelumab
Nivolumab*
Cisplatin-ineligible PD-L1-positive tumors† Atezolizumab*
Pembrolizumab*
PD-L1-negative tumors† Carboplatin-based chemotherapy
Cisplatin- and carboplatin-ineligible Atezolizumab‡*
Pembrolizumab‡*

Individual rows represent treatment decision options that can be followed from left to right horizontally in adjacent columns.

*Accelerated approvals contingent on confirmatory trials at the time of guideline publication.

†As determined by the appropriate FDA-approved companion diagnostic (ie, PD-L1 staining immune cells (IC) ≥5% of the tumor area by SP142 assay for atezolizumab and combined positive score (CPS) ≥10 by IHC 22C3 assay for pembrolizumab).

‡Recommendation based on US-only indication.

mUC, advanced/metastatic urothelial cancer; PD-L1, programmed death-ligand 1.