Fast Five Quiz: Management of Metastatic Bladder Cancer

Kyle A. Richards, MD

Disclosures

March 24, 2022

The approval of several checkpoint inhibitors has changed the way metastatic bladder cancer is managed. However, the only immunotherapy associated with an increase in overall survival is pembrolizumab. In 2017, the US Food and Drug Administration approved pembrolizumab for the use of solid tumors that progressed during or after prior initial therapy; immunotherapy has not yet been approved in Europe. Clinical trials have shown a response in refractory settings in both programmed death-ligand 1 (PD-L1)–positive and –negative tumors. The phase 2 KEYNOTE-052 trial suggests that pembrolizumab be used as first-line therapy in patients who are PD-L1 positive and not eligible for platinum-based regimens.

Carboplatin-based chemotherapy (carboplatin with gemcitabine) is recommended as first-line treatment in patients who are unfit for cisplatin. Analyses have demonstrated superior outcomes compared with immunotherapy.

Learn more about metastatic bladder cancer management.

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