ESMO 2021 | Optimal treatment strategies for patients with metastatic urothelial carcinoma

Richard Cathomas, MD, PhD, Hospital Graubünden, Chur, Switzerland, comments on patient-related factors that influence treatment decisions and describes optimal first-line treatment strategies for patients with metastatic urothelial carcinoma. It is firstly essential to determine whether a patient is eligible for platinum-based chemotherapy with carboplatin or cisplatin, based on ECOG performance status, glomerular filtration rate (GFR) and presence of other comorbidities. Patients treated with cisplatin-based chemotherapy need to have a GFR of at least 50 ml/min. Current standard of care consists of cisplatin plus gemcitabine or dose-dense (DD)-MVAC, or carboplatin with gemcitabine. PD-L1 inhibitors can be used as a maintenance therapy once a patient’s disease is stable following first-line chemotherapy. Only patients that are ineligible for platinum-based chemotherapy should be considered for pembrolizumab or atezolizumab monotherapy in the first-line setting. This interview took place at the European Society for Medical Oncology (ESMO) 2021 congress.