SEOM-SOGUG clinical guideline for localized muscle invasive and advanced bladder cancer (2021)

Abstract Most muscle-invasive bladder cancer (BC) are urothelial carcinomas (UC) of transitional origin, although histological variants of UC have been recognized. Smoking is the most important risk factor in developed countries, and the basis for prevention. UC harbors high number of genomic aberrations that make possible targeted therapies. Based on molecular features, a consensus classification identified six different MIBC subtypes. Hematuria and irritative bladder symptoms, CT scan, cystoscopy and transurethral resection are the basis for diagnosis. Radical cystectomy with pelvic lymphadenectomy is the standard approach for muscle-invasive BC, although bladder preservation is an option for selected patients who wish to avoid or cannot tolerate surgery. Perioperative cisplatin-based neoadjuvant chemotherapy is recommended for cT2-4aN0M0 tumors, or as adjuvant in patients with pT3/4 and or pN + after radical cystectomy. Follow-up is particularly important after the availability of new salvage therapies. It should be individualized and adapted to the risk of recurrence. Cisplatin–gemcitabine is considered the standard first line for metastatic tumors. Carboplatin should replace cisplatin in cisplatin-ineligible patients. According to the EMA label, pembrolizumab or atezolizumab could be an option in cisplatin-ineligible patients with high PD-L1 expression. For patients whose disease respond or did not progress after first-line platinum chemotherapy, maintenance with avelumab prolongs survival with respect to the best supportive care. Pembrolizumab also increases survival versus vinflunine or taxanes in patients with progression after chemotherapy who have not received avelumab, as well as enfortumab vedotin in those progressing to first-line chemotherapy followed by an antiPDL1/PD1. Erdafitinib may be considered in this setting in patients with FGFR alterations. An early onset of supportive and palliative care is always strongly recommended. Ausführliche Beschreibung

Gespeichert in:

Autor*in:	Valderrama, Begoña P. [verfasserIn] González-del-Alba, Aránzazu Morales-Barrera, Rafael Peláez Fernández, Ignacio Vázquez, Sergio Caballero Díaz, Cristina Domènech, Montserrat Fernández Calvo, Ovidio Gómez de Liaño Lista, Alfonso Arranz Arija, José Ángel

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2022

Schlagwörter:	Bladder cancer Urothelial Muscle-invasive

Anmerkung:	© The Author(s) 2022

Übergeordnetes Werk:	Enthalten in: Revista de oncología - Barcelona : Doyma, 2000, 24(2022), 4 vom: 26. März, Seite 613-624
Übergeordnetes Werk:	volume:24 ; year:2022 ; number:4 ; day:26 ; month:03 ; pages:613-624

Links:	Volltext

DOI / URN:	10.1007/s12094-022-02815-w

Katalog-ID:	SPR046684700

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allfields	10.1007/s12094-022-02815-w doi (DE-627)SPR046684700 (SPR)s12094-022-02815-w-e DE-627 ger DE-627 rakwb eng Valderrama, Begoña P. verfasserin (orcid)0000-0003-0175-1263 aut SEOM-SOGUG clinical guideline for localized muscle invasive and advanced bladder cancer (2021) 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2022 Abstract Most muscle-invasive bladder cancer (BC) are urothelial carcinomas (UC) of transitional origin, although histological variants of UC have been recognized. Smoking is the most important risk factor in developed countries, and the basis for prevention. UC harbors high number of genomic aberrations that make possible targeted therapies. Based on molecular features, a consensus classification identified six different MIBC subtypes. Hematuria and irritative bladder symptoms, CT scan, cystoscopy and transurethral resection are the basis for diagnosis. Radical cystectomy with pelvic lymphadenectomy is the standard approach for muscle-invasive BC, although bladder preservation is an option for selected patients who wish to avoid or cannot tolerate surgery. Perioperative cisplatin-based neoadjuvant chemotherapy is recommended for cT2-4aN0M0 tumors, or as adjuvant in patients with pT3/4 and or pN + after radical cystectomy. Follow-up is particularly important after the availability of new salvage therapies. It should be individualized and adapted to the risk of recurrence. Cisplatin–gemcitabine is considered the standard first line for metastatic tumors. Carboplatin should replace cisplatin in cisplatin-ineligible patients. According to the EMA label, pembrolizumab or atezolizumab could be an option in cisplatin-ineligible patients with high PD-L1 expression. For patients whose disease respond or did not progress after first-line platinum chemotherapy, maintenance with avelumab prolongs survival with respect to the best supportive care. Pembrolizumab also increases survival versus vinflunine or taxanes in patients with progression after chemotherapy who have not received avelumab, as well as enfortumab vedotin in those progressing to first-line chemotherapy followed by an antiPDL1/PD1. Erdafitinib may be considered in this setting in patients with FGFR alterations. An early onset of supportive and palliative care is always strongly recommended. Bladder cancer (dpeaa)DE-He213 Urothelial (dpeaa)DE-He213 Muscle-invasive (dpeaa)DE-He213 González-del-Alba, Aránzazu aut Morales-Barrera, Rafael aut Peláez Fernández, Ignacio aut Vázquez, Sergio aut Caballero Díaz, Cristina aut Domènech, Montserrat aut Fernández Calvo, Ovidio aut Gómez de Liaño Lista, Alfonso aut Arranz Arija, José Ángel aut Enthalten in Revista de oncología Barcelona : Doyma, 2000 24(2022), 4 vom: 26. März, Seite 613-624 (DE-627)385985452 (DE-600)2143451-7 1578-195X nnns volume:24 year:2022 number:4 day:26 month:03 pages:613-624 https://dx.doi.org/10.1007/s12094-022-02815-w kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_105 GBV_ILN_120 GBV_ILN_152 GBV_ILN_161 GBV_ILN_171 GBV_ILN_187 GBV_ILN_224 GBV_ILN_250 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 AR 24 2022 4 26 03 613-624
spelling	10.1007/s12094-022-02815-w doi (DE-627)SPR046684700 (SPR)s12094-022-02815-w-e DE-627 ger DE-627 rakwb eng Valderrama, Begoña P. verfasserin (orcid)0000-0003-0175-1263 aut SEOM-SOGUG clinical guideline for localized muscle invasive and advanced bladder cancer (2021) 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2022 Abstract Most muscle-invasive bladder cancer (BC) are urothelial carcinomas (UC) of transitional origin, although histological variants of UC have been recognized. Smoking is the most important risk factor in developed countries, and the basis for prevention. UC harbors high number of genomic aberrations that make possible targeted therapies. Based on molecular features, a consensus classification identified six different MIBC subtypes. Hematuria and irritative bladder symptoms, CT scan, cystoscopy and transurethral resection are the basis for diagnosis. Radical cystectomy with pelvic lymphadenectomy is the standard approach for muscle-invasive BC, although bladder preservation is an option for selected patients who wish to avoid or cannot tolerate surgery. Perioperative cisplatin-based neoadjuvant chemotherapy is recommended for cT2-4aN0M0 tumors, or as adjuvant in patients with pT3/4 and or pN + after radical cystectomy. Follow-up is particularly important after the availability of new salvage therapies. It should be individualized and adapted to the risk of recurrence. Cisplatin–gemcitabine is considered the standard first line for metastatic tumors. Carboplatin should replace cisplatin in cisplatin-ineligible patients. According to the EMA label, pembrolizumab or atezolizumab could be an option in cisplatin-ineligible patients with high PD-L1 expression. For patients whose disease respond or did not progress after first-line platinum chemotherapy, maintenance with avelumab prolongs survival with respect to the best supportive care. Pembrolizumab also increases survival versus vinflunine or taxanes in patients with progression after chemotherapy who have not received avelumab, as well as enfortumab vedotin in those progressing to first-line chemotherapy followed by an antiPDL1/PD1. Erdafitinib may be considered in this setting in patients with FGFR alterations. An early onset of supportive and palliative care is always strongly recommended. Bladder cancer (dpeaa)DE-He213 Urothelial (dpeaa)DE-He213 Muscle-invasive (dpeaa)DE-He213 González-del-Alba, Aránzazu aut Morales-Barrera, Rafael aut Peláez Fernández, Ignacio aut Vázquez, Sergio aut Caballero Díaz, Cristina aut Domènech, Montserrat aut Fernández Calvo, Ovidio aut Gómez de Liaño Lista, Alfonso aut Arranz Arija, José Ángel aut Enthalten in Revista de oncología Barcelona : Doyma, 2000 24(2022), 4 vom: 26. März, Seite 613-624 (DE-627)385985452 (DE-600)2143451-7 1578-195X nnns volume:24 year:2022 number:4 day:26 month:03 pages:613-624 https://dx.doi.org/10.1007/s12094-022-02815-w kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_105 GBV_ILN_120 GBV_ILN_152 GBV_ILN_161 GBV_ILN_171 GBV_ILN_187 GBV_ILN_224 GBV_ILN_250 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 AR 24 2022 4 26 03 613-624
allfields_unstemmed	10.1007/s12094-022-02815-w doi (DE-627)SPR046684700 (SPR)s12094-022-02815-w-e DE-627 ger DE-627 rakwb eng Valderrama, Begoña P. verfasserin (orcid)0000-0003-0175-1263 aut SEOM-SOGUG clinical guideline for localized muscle invasive and advanced bladder cancer (2021) 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2022 Abstract Most muscle-invasive bladder cancer (BC) are urothelial carcinomas (UC) of transitional origin, although histological variants of UC have been recognized. Smoking is the most important risk factor in developed countries, and the basis for prevention. UC harbors high number of genomic aberrations that make possible targeted therapies. Based on molecular features, a consensus classification identified six different MIBC subtypes. Hematuria and irritative bladder symptoms, CT scan, cystoscopy and transurethral resection are the basis for diagnosis. Radical cystectomy with pelvic lymphadenectomy is the standard approach for muscle-invasive BC, although bladder preservation is an option for selected patients who wish to avoid or cannot tolerate surgery. Perioperative cisplatin-based neoadjuvant chemotherapy is recommended for cT2-4aN0M0 tumors, or as adjuvant in patients with pT3/4 and or pN + after radical cystectomy. Follow-up is particularly important after the availability of new salvage therapies. It should be individualized and adapted to the risk of recurrence. Cisplatin–gemcitabine is considered the standard first line for metastatic tumors. Carboplatin should replace cisplatin in cisplatin-ineligible patients. According to the EMA label, pembrolizumab or atezolizumab could be an option in cisplatin-ineligible patients with high PD-L1 expression. For patients whose disease respond or did not progress after first-line platinum chemotherapy, maintenance with avelumab prolongs survival with respect to the best supportive care. Pembrolizumab also increases survival versus vinflunine or taxanes in patients with progression after chemotherapy who have not received avelumab, as well as enfortumab vedotin in those progressing to first-line chemotherapy followed by an antiPDL1/PD1. Erdafitinib may be considered in this setting in patients with FGFR alterations. An early onset of supportive and palliative care is always strongly recommended. Bladder cancer (dpeaa)DE-He213 Urothelial (dpeaa)DE-He213 Muscle-invasive (dpeaa)DE-He213 González-del-Alba, Aránzazu aut Morales-Barrera, Rafael aut Peláez Fernández, Ignacio aut Vázquez, Sergio aut Caballero Díaz, Cristina aut Domènech, Montserrat aut Fernández Calvo, Ovidio aut Gómez de Liaño Lista, Alfonso aut Arranz Arija, José Ángel aut Enthalten in Revista de oncología Barcelona : Doyma, 2000 24(2022), 4 vom: 26. März, Seite 613-624 (DE-627)385985452 (DE-600)2143451-7 1578-195X nnns volume:24 year:2022 number:4 day:26 month:03 pages:613-624 https://dx.doi.org/10.1007/s12094-022-02815-w kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_105 GBV_ILN_120 GBV_ILN_152 GBV_ILN_161 GBV_ILN_171 GBV_ILN_187 GBV_ILN_224 GBV_ILN_250 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 AR 24 2022 4 26 03 613-624
allfieldsGer	10.1007/s12094-022-02815-w doi (DE-627)SPR046684700 (SPR)s12094-022-02815-w-e DE-627 ger DE-627 rakwb eng Valderrama, Begoña P. verfasserin (orcid)0000-0003-0175-1263 aut SEOM-SOGUG clinical guideline for localized muscle invasive and advanced bladder cancer (2021) 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2022 Abstract Most muscle-invasive bladder cancer (BC) are urothelial carcinomas (UC) of transitional origin, although histological variants of UC have been recognized. Smoking is the most important risk factor in developed countries, and the basis for prevention. UC harbors high number of genomic aberrations that make possible targeted therapies. Based on molecular features, a consensus classification identified six different MIBC subtypes. Hematuria and irritative bladder symptoms, CT scan, cystoscopy and transurethral resection are the basis for diagnosis. Radical cystectomy with pelvic lymphadenectomy is the standard approach for muscle-invasive BC, although bladder preservation is an option for selected patients who wish to avoid or cannot tolerate surgery. Perioperative cisplatin-based neoadjuvant chemotherapy is recommended for cT2-4aN0M0 tumors, or as adjuvant in patients with pT3/4 and or pN + after radical cystectomy. Follow-up is particularly important after the availability of new salvage therapies. It should be individualized and adapted to the risk of recurrence. Cisplatin–gemcitabine is considered the standard first line for metastatic tumors. Carboplatin should replace cisplatin in cisplatin-ineligible patients. According to the EMA label, pembrolizumab or atezolizumab could be an option in cisplatin-ineligible patients with high PD-L1 expression. For patients whose disease respond or did not progress after first-line platinum chemotherapy, maintenance with avelumab prolongs survival with respect to the best supportive care. Pembrolizumab also increases survival versus vinflunine or taxanes in patients with progression after chemotherapy who have not received avelumab, as well as enfortumab vedotin in those progressing to first-line chemotherapy followed by an antiPDL1/PD1. Erdafitinib may be considered in this setting in patients with FGFR alterations. An early onset of supportive and palliative care is always strongly recommended. Bladder cancer (dpeaa)DE-He213 Urothelial (dpeaa)DE-He213 Muscle-invasive (dpeaa)DE-He213 González-del-Alba, Aránzazu aut Morales-Barrera, Rafael aut Peláez Fernández, Ignacio aut Vázquez, Sergio aut Caballero Díaz, Cristina aut Domènech, Montserrat aut Fernández Calvo, Ovidio aut Gómez de Liaño Lista, Alfonso aut Arranz Arija, José Ángel aut Enthalten in Revista de oncología Barcelona : Doyma, 2000 24(2022), 4 vom: 26. März, Seite 613-624 (DE-627)385985452 (DE-600)2143451-7 1578-195X nnns volume:24 year:2022 number:4 day:26 month:03 pages:613-624 https://dx.doi.org/10.1007/s12094-022-02815-w kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_105 GBV_ILN_120 GBV_ILN_152 GBV_ILN_161 GBV_ILN_171 GBV_ILN_187 GBV_ILN_224 GBV_ILN_250 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 AR 24 2022 4 26 03 613-624
allfieldsSound	10.1007/s12094-022-02815-w doi (DE-627)SPR046684700 (SPR)s12094-022-02815-w-e DE-627 ger DE-627 rakwb eng Valderrama, Begoña P. verfasserin (orcid)0000-0003-0175-1263 aut SEOM-SOGUG clinical guideline for localized muscle invasive and advanced bladder cancer (2021) 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2022 Abstract Most muscle-invasive bladder cancer (BC) are urothelial carcinomas (UC) of transitional origin, although histological variants of UC have been recognized. Smoking is the most important risk factor in developed countries, and the basis for prevention. UC harbors high number of genomic aberrations that make possible targeted therapies. Based on molecular features, a consensus classification identified six different MIBC subtypes. Hematuria and irritative bladder symptoms, CT scan, cystoscopy and transurethral resection are the basis for diagnosis. Radical cystectomy with pelvic lymphadenectomy is the standard approach for muscle-invasive BC, although bladder preservation is an option for selected patients who wish to avoid or cannot tolerate surgery. Perioperative cisplatin-based neoadjuvant chemotherapy is recommended for cT2-4aN0M0 tumors, or as adjuvant in patients with pT3/4 and or pN + after radical cystectomy. Follow-up is particularly important after the availability of new salvage therapies. It should be individualized and adapted to the risk of recurrence. Cisplatin–gemcitabine is considered the standard first line for metastatic tumors. Carboplatin should replace cisplatin in cisplatin-ineligible patients. According to the EMA label, pembrolizumab or atezolizumab could be an option in cisplatin-ineligible patients with high PD-L1 expression. For patients whose disease respond or did not progress after first-line platinum chemotherapy, maintenance with avelumab prolongs survival with respect to the best supportive care. Pembrolizumab also increases survival versus vinflunine or taxanes in patients with progression after chemotherapy who have not received avelumab, as well as enfortumab vedotin in those progressing to first-line chemotherapy followed by an antiPDL1/PD1. Erdafitinib may be considered in this setting in patients with FGFR alterations. An early onset of supportive and palliative care is always strongly recommended. Bladder cancer (dpeaa)DE-He213 Urothelial (dpeaa)DE-He213 Muscle-invasive (dpeaa)DE-He213 González-del-Alba, Aránzazu aut Morales-Barrera, Rafael aut Peláez Fernández, Ignacio aut Vázquez, Sergio aut Caballero Díaz, Cristina aut Domènech, Montserrat aut Fernández Calvo, Ovidio aut Gómez de Liaño Lista, Alfonso aut Arranz Arija, José Ángel aut Enthalten in Revista de oncología Barcelona : Doyma, 2000 24(2022), 4 vom: 26. März, Seite 613-624 (DE-627)385985452 (DE-600)2143451-7 1578-195X nnns volume:24 year:2022 number:4 day:26 month:03 pages:613-624 https://dx.doi.org/10.1007/s12094-022-02815-w kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_90 GBV_ILN_95 GBV_ILN_100 GBV_ILN_105 GBV_ILN_120 GBV_ILN_152 GBV_ILN_161 GBV_ILN_171 GBV_ILN_187 GBV_ILN_224 GBV_ILN_250 GBV_ILN_281 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 AR 24 2022 4 26 03 613-624
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source	Enthalten in Revista de oncología 24(2022), 4 vom: 26. März, Seite 613-624 volume:24 year:2022 number:4 day:26 month:03 pages:613-624
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author	Valderrama, Begoña P.
spellingShingle	Valderrama, Begoña P. misc Bladder cancer misc Urothelial misc Muscle-invasive SEOM-SOGUG clinical guideline for localized muscle invasive and advanced bladder cancer (2021)
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topic_title	SEOM-SOGUG clinical guideline for localized muscle invasive and advanced bladder cancer (2021) Bladder cancer (dpeaa)DE-He213 Urothelial (dpeaa)DE-He213 Muscle-invasive (dpeaa)DE-He213
topic	misc Bladder cancer misc Urothelial misc Muscle-invasive
topic_unstemmed	misc Bladder cancer misc Urothelial misc Muscle-invasive
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title	SEOM-SOGUG clinical guideline for localized muscle invasive and advanced bladder cancer (2021)
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title_full	SEOM-SOGUG clinical guideline for localized muscle invasive and advanced bladder cancer (2021)
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author_browse	Valderrama, Begoña P. González-del-Alba, Aránzazu Morales-Barrera, Rafael Peláez Fernández, Ignacio Vázquez, Sergio Caballero Díaz, Cristina Domènech, Montserrat Fernández Calvo, Ovidio Gómez de Liaño Lista, Alfonso Arranz Arija, José Ángel
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title_sort	seom-sogug clinical guideline for localized muscle invasive and advanced bladder cancer (2021)
title_auth	SEOM-SOGUG clinical guideline for localized muscle invasive and advanced bladder cancer (2021)
abstract	Abstract Most muscle-invasive bladder cancer (BC) are urothelial carcinomas (UC) of transitional origin, although histological variants of UC have been recognized. Smoking is the most important risk factor in developed countries, and the basis for prevention. UC harbors high number of genomic aberrations that make possible targeted therapies. Based on molecular features, a consensus classification identified six different MIBC subtypes. Hematuria and irritative bladder symptoms, CT scan, cystoscopy and transurethral resection are the basis for diagnosis. Radical cystectomy with pelvic lymphadenectomy is the standard approach for muscle-invasive BC, although bladder preservation is an option for selected patients who wish to avoid or cannot tolerate surgery. Perioperative cisplatin-based neoadjuvant chemotherapy is recommended for cT2-4aN0M0 tumors, or as adjuvant in patients with pT3/4 and or pN + after radical cystectomy. Follow-up is particularly important after the availability of new salvage therapies. It should be individualized and adapted to the risk of recurrence. Cisplatin–gemcitabine is considered the standard first line for metastatic tumors. Carboplatin should replace cisplatin in cisplatin-ineligible patients. According to the EMA label, pembrolizumab or atezolizumab could be an option in cisplatin-ineligible patients with high PD-L1 expression. For patients whose disease respond or did not progress after first-line platinum chemotherapy, maintenance with avelumab prolongs survival with respect to the best supportive care. Pembrolizumab also increases survival versus vinflunine or taxanes in patients with progression after chemotherapy who have not received avelumab, as well as enfortumab vedotin in those progressing to first-line chemotherapy followed by an antiPDL1/PD1. Erdafitinib may be considered in this setting in patients with FGFR alterations. An early onset of supportive and palliative care is always strongly recommended. © The Author(s) 2022
abstractGer	Abstract Most muscle-invasive bladder cancer (BC) are urothelial carcinomas (UC) of transitional origin, although histological variants of UC have been recognized. Smoking is the most important risk factor in developed countries, and the basis for prevention. UC harbors high number of genomic aberrations that make possible targeted therapies. Based on molecular features, a consensus classification identified six different MIBC subtypes. Hematuria and irritative bladder symptoms, CT scan, cystoscopy and transurethral resection are the basis for diagnosis. Radical cystectomy with pelvic lymphadenectomy is the standard approach for muscle-invasive BC, although bladder preservation is an option for selected patients who wish to avoid or cannot tolerate surgery. Perioperative cisplatin-based neoadjuvant chemotherapy is recommended for cT2-4aN0M0 tumors, or as adjuvant in patients with pT3/4 and or pN + after radical cystectomy. Follow-up is particularly important after the availability of new salvage therapies. It should be individualized and adapted to the risk of recurrence. Cisplatin–gemcitabine is considered the standard first line for metastatic tumors. Carboplatin should replace cisplatin in cisplatin-ineligible patients. According to the EMA label, pembrolizumab or atezolizumab could be an option in cisplatin-ineligible patients with high PD-L1 expression. For patients whose disease respond or did not progress after first-line platinum chemotherapy, maintenance with avelumab prolongs survival with respect to the best supportive care. Pembrolizumab also increases survival versus vinflunine or taxanes in patients with progression after chemotherapy who have not received avelumab, as well as enfortumab vedotin in those progressing to first-line chemotherapy followed by an antiPDL1/PD1. Erdafitinib may be considered in this setting in patients with FGFR alterations. An early onset of supportive and palliative care is always strongly recommended. © The Author(s) 2022
abstract_unstemmed	Abstract Most muscle-invasive bladder cancer (BC) are urothelial carcinomas (UC) of transitional origin, although histological variants of UC have been recognized. Smoking is the most important risk factor in developed countries, and the basis for prevention. UC harbors high number of genomic aberrations that make possible targeted therapies. Based on molecular features, a consensus classification identified six different MIBC subtypes. Hematuria and irritative bladder symptoms, CT scan, cystoscopy and transurethral resection are the basis for diagnosis. Radical cystectomy with pelvic lymphadenectomy is the standard approach for muscle-invasive BC, although bladder preservation is an option for selected patients who wish to avoid or cannot tolerate surgery. Perioperative cisplatin-based neoadjuvant chemotherapy is recommended for cT2-4aN0M0 tumors, or as adjuvant in patients with pT3/4 and or pN + after radical cystectomy. Follow-up is particularly important after the availability of new salvage therapies. It should be individualized and adapted to the risk of recurrence. Cisplatin–gemcitabine is considered the standard first line for metastatic tumors. Carboplatin should replace cisplatin in cisplatin-ineligible patients. According to the EMA label, pembrolizumab or atezolizumab could be an option in cisplatin-ineligible patients with high PD-L1 expression. For patients whose disease respond or did not progress after first-line platinum chemotherapy, maintenance with avelumab prolongs survival with respect to the best supportive care. Pembrolizumab also increases survival versus vinflunine or taxanes in patients with progression after chemotherapy who have not received avelumab, as well as enfortumab vedotin in those progressing to first-line chemotherapy followed by an antiPDL1/PD1. Erdafitinib may be considered in this setting in patients with FGFR alterations. An early onset of supportive and palliative care is always strongly recommended. © The Author(s) 2022
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title_short	SEOM-SOGUG clinical guideline for localized muscle invasive and advanced bladder cancer (2021)
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Cisplatin–gemcitabine is considered the standard first line for metastatic tumors. Carboplatin should replace cisplatin in cisplatin-ineligible patients. According to the EMA label, pembrolizumab or atezolizumab could be an option in cisplatin-ineligible patients with high PD-L1 expression. For patients whose disease respond or did not progress after first-line platinum chemotherapy, maintenance with avelumab prolongs survival with respect to the best supportive care. Pembrolizumab also increases survival versus vinflunine or taxanes in patients with progression after chemotherapy who have not received avelumab, as well as enfortumab vedotin in those progressing to first-line chemotherapy followed by an antiPDL1/PD1. Erdafitinib may be considered in this setting in patients with FGFR alterations. 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