NCCN Updates Therapy Guidelines in Bladder Cancer

At the recent 2022 National Comprehensive Cancer Network (NCCN) Annual Conference, Thomas W Flaig, MD, Professor of Medicine, Vice Chancellor for Research, University of Colorado Anschutz Medical Campus, and Chair of the NCCN Guidelines Panel for Bladder Cancer presented data evaluating new treatment options in bladder cancer, as well as relevant updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Bladder Cancer.

Dr Flaig stated, “The landscape for the treatment of bladder cancer has changed remarkably and rapidly over the past several years.” Moreover, the emergence of new systemic therapies, approval of PD-1 and PD-L1 inhibitors, and progress in the development of biomarkers have revolutionized the management of this urologic malignancy.

Current NCCN guidelines continue to recommend gemcitabine plus cisplatin or dose-dense methotrexate/vinblastine/doxorubicin/cisplatin (MVAC) as a first line treatment for cisplatin-eligible patients. However, new guideline updates now recommend to use avelumab as maintenance therapy. Immune checkpoint inhibitors (ICIs) are also highlighted as an alternative treatment for patients with PD-1-positive or platinum-ineligible disease.

The current NCCN guidelines also note that pembrolizumab is the preferred regimen for patients with locally advanced or metastatic disease who have received chemotherapy. Alternative regimens include, nivolumab, avelumab, erdafitinib, and enfortumab vedotin. Enfortumab vedotin and gemcitabine + carboplatin are also recommended as second-line treatment options for patients who have received ICIs.

According to Dr Flaig, the NCCN Guidelines also provide recommendations for adjuvant therapy. “In the past, we have simply [considered] chemotherapy if patients had not received it and have significant disease observed at the time of surgery,” adding, “Now, we have the option of including nivolumab in patients who have a certain level of residual disease after receiving cisplatin-based chemotherapy [or in those who] have not received chemotherapy.”