From the Guidelines
For second-line treatment of urinary bladder cancer, pembrolizumab is the recommended option, as it has shown a longer median overall survival and fewer treatment-related adverse events compared to chemotherapy, as demonstrated in a phase III trial 1. The choice of second-line treatment for urinary bladder cancer depends on various factors, including the patient's previous treatments, overall health, and cancer characteristics.
- Pembrolizumab, a PD-1 inhibitor, has been evaluated as second-line therapy for patients with bladder cancer who previously received platinum-based therapy and subsequently progressed or metastasized, with a category 1 recommendation as a second-line therapy 1.
- Other options, such as atezolizumab, nivolumab, durvalumab, and avelumab, have also been approved for the treatment of locally advanced or metastatic urothelial cell carcinoma that has progressed during or after platinum-based chemotherapy, but pembrolizumab has the strongest evidence supporting its use as a second-line treatment 1.
- The European Association of Urology guidelines recommend offering pembrolizumab to patients experiencing disease progression during or after platinum-based combination chemotherapy for metastatic disease, with a strong strength rating 1.
- It is essential to consider the patient's quality of life and overall health when making treatment decisions, as well as to monitor treatment response and detect recurrence early through regular follow-up with cystoscopy and cytology.
- The treatment options should be discussed with the patient, and the decision should be made based on the individual patient's needs and preferences.
- In addition to pembrolizumab, other treatment options, such as enfortumab vedotin, sacituzumab govitecan, and FGFR tyrosine kinase inhibitors, may be considered for patients with advanced or metastatic urothelial carcinoma who have progressed after platinum chemotherapy and immunotherapy 1.
From the FDA Drug Label
Valrubicin intravesical solution is an anthracycline topoisomerase inhibitor indicated for intravesical therapy of BCG-refractory carcinoma in situ (CIS) of the urinary bladder in patients for whom immediate cystectomy would be associated with unacceptable morbidity or mortality. The second-line treatment option for carcinoma (CA) of the urinary bladder is Valrubicin intravesical solution for BCG-refractory carcinoma in situ (CIS) of the urinary bladder 2.
- It is used when immediate cystectomy would be associated with unacceptable morbidity or mortality.
- The recommended dose is 800 mg administered intravesically once a week for six weeks.
From the Research
Second-Line Treatment Options for Carcinoma of the Urinary Bladder
- The following second-line treatment options are available for carcinoma of the urinary bladder:
- Pembrolizumab, avelumab, and nivolumab are approved for second-line therapy in patients who experience progression during or after platinum-containing chemotherapy 3
- Erdafitinib is indicated for advanced disease that has susceptible FGFR2 or FGFR3 genetic alterations and has progressed during or after treatment with at least one line of platinum-containing chemotherapy 3
- Enfortumab vedotin and sacituzumab govitecan are antibody-drug conjugates approved for patients who have received anti-PD-L1 or anti-PD-1 therapy and treatment with platinum-containing chemotherapy 3
- Vinflunine plus best supportive care is approved by the EMA with moderate clinical efficacy 4
- Gemcitabine and docetaxel (GD) therapy is also used as a second-line treatment for metastatic urothelial carcinoma (mUC) patients 5
- The choice of second-line treatment may depend on factors such as the patient's previous treatment history, performance status, and tumor characteristics
- Immunotherapeutic strategies, such as pembrolizumab, have shown promising activity in second-line treatment of urothelial cancer 4, 6
- Novel targeted therapies are being developed to further improve the delivery and efficacy of chemotherapy for advanced urothelial carcinoma 4, 7