Fast Five Quiz: Management of Metastatic Bladder Cancer

Kyle A. Richards, MD


January 30, 2023

For medically fit patients with metastatic bladder cancer, cisplatin-based combination chemotherapy is the standard of care for first-line treatment. The most common systemic regimens include methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC), either classic or dose-dense MVAC regimens, and doublet therapy with cisplatin and gemcitabine. With cisplatin-based combination chemotherapy, the median progression-free survival is 7 months and median overall survival is 15 months. Although bladder cancer is chemotherapy-sensitive, the risk for recurrence is estimated to be up to 61% the first year and up to 78% by year 5.

Compared with single-agent cisplatin therapy, MVAC has demonstrated improved overall response rates, median progression-free survival, and median overall survival, according to Loehrer Sr and colleagues.

The antibody-drug conjugate enfortumab vedotin combined with the checkpoint inhibitor pembrolizumab has shown positive results in a clinical trial among patients with metastatic bladder cancer. Its promising results are predicted to lead to an accelerated approval for this drug regimen as a first-line treatment for people with metastatic bladder cancer who cannot receive cisplatin-based chemotherapy.

Intravesical chemotherapy may be an option for early-stage localized bladder cancers.

Radical cystectomy may be an option for localized muscle-invasive bladder cancer after neoadjuvant chemotherapy.

Learn more about metastatic bladder cancer management.


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