ECOG: Eastern Cooperative Oncology Group; MVAC: methotrexate, vinblastine, doxorubicin, and cisplatin; NYHA: New York Heart Association.
* Some patients may be poor candidates for enfortumab vedotin, such as those with uncontolled diabetes mellitus, severe dermatologic conditions, severe neuropathy, and/or impaired kidney function.
¶ While enfortumab vedotin can be administered until disease progression or unacceptable toxicity, it is typically administered in combination with pembrolizumab for a median of 7 to 9 cycles, if tolerable, mainly to avoid the risk of cumulative neurotoxicity. Pembrolizumab is then continued as monotherapy for up to 24 months or until disease progression or unacceptable toxicity during that period.
Δ Creatinine clearance <60 mL/min is not a contraindication to cisplatin chemotherapy if kidney function is due to tumor obstruction and can be reversed.
◊ Either option is appropriate, as the optimal sequencing of chemotherapy and immunotherapy (concurrent versus sequential) is not established.
§ Nivolumab is administered in combination with gemcitabine and cisplatin every 3 weeks for up to 6 cycles. Nivolumab is then continued as monotherapy for up to 24 months or until disease progression or unacceptable toxicity during that period.
¥ The choice between available cisplatin-based regimens is individualized based on patient and provider preferences.
‡ For patients without disease progression on platinum-based chemotherapy regimens, we offer maintenance avelumab. Patients without disease progression who are not eligible for maintenance immunotherapy may be observed with best supportive care.
† Patients who are candidates for carboplatin-based combination therapy may have appropriate performance status but otherwise be ineligible for cisplatin-based combination chemotherapy due to kidney dysfunction, neuropathy, severe hearing loss, and/or heart failure.
** Patients not eligible for this regimen may be offered single-agent chemotherapy as an alternative. Options include carboplatin, gemcitabine, vinflunine (where available), anthracyclines, methotrexate, taxanes, and ifosfamide.Do you want to add Medilib to your home screen?