| Evolent Pathways | Febrile Neutropenic Risk | Emetogenic Risk | References | ||
|---|---|---|---|---|---|
| POST-OP LOW/MOD RISK - NON-INVASIVE | |||||
Any intra-vesicle |
Not Applicable | Not applicable |
|
||
| PERIOPERATIVE | |||||
durvalumab, gemcitabine and cisplatin as neoadjuvant treatment, followed by single agent durvalumab as adjuvant treatment following radical cystectomy |
Intermediate | High |
|
||
| STAGE III | |||||
Neoadjuvant |
DD-MVAC (dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin) |
High | High |
|
|
cisplatin and gemcitabine |
Low | High |
|
||
Adjuvant |
DD-MVAC (dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin) |
High | High |
|
|
cisplatin and gemcitabine *post-surgery only, not with radiation* |
Low | High |
|
||
| ADVANCED/METASTATIC | |||||
Initial Therapy |
cisplatin and gemcitabine |
Low | High |
|
|
carboplatin and gemcitabine |
Low | Moderate |
|
||
nivolumab, gemcitabine and cisplatin |
Low | High |
|
||
Initial Therapy (for patients not eligible for any platinum-containing chemotherapy) |
gemcitabine |
Low | Low |
|
|
pembrolizumab |
Low | Low |
|
||
Maintenance |
avelumab *if no progression following first-line platinum-containing chemotherapy* |
Low | Moderate |
|
|
Subsequent Therapy |
gemcitabine |
Low | Low |
|
|
pembrolizumab *failed prior platinum based chemotherapy* |
Low | Low |
|
||
gemcitabine and cisplatin |
Low | High |
|
||
gemcitabine and carboplatin |
Low | High |
|
||
paclitaxel |
Low | Low |
|
||
docetaxel |
Low | Low |
|
||
Best Supportive Care or Clinical Trial |
Not Applicable | Not applicable |
|
||
Any intra-vesicle
durvalumab, gemcitabine and cisplatin as neoadjuvant treatment, followed by single agent durvalumab as adjuvant treatment following radical cystectomy
Neoadjuvant
DD-MVAC (dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin)
cisplatin and gemcitabine
Adjuvant
DD-MVAC (dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin)
cisplatin and gemcitabine *post-surgery only, not with radiation*
Initial Therapy
cisplatin and gemcitabine
carboplatin and gemcitabine
nivolumab, gemcitabine and cisplatin
Initial Therapy (for patients not eligible for any platinum-containing chemotherapy)
gemcitabine
pembrolizumab
Maintenance
avelumab *if no progression following first-line platinum-containing chemotherapy*
Subsequent Therapy
gemcitabine
pembrolizumab *failed prior platinum based chemotherapy*
gemcitabine and cisplatin
gemcitabine and carboplatin
paclitaxel
docetaxel
Best Supportive Care or Clinical Trial
| Regimen | Alternative | References | |||
|---|---|---|---|---|---|
| LOW VALUE REGIMENS (NON-PATHWAY) WITH SUPERIOR ALTERNATIVES | |||||
Neoadjuvant Therapy |
** capecitabine ** |
Alternative: gemcitabine + cisplatin |
|||
Subsequent Therapy |
** DD-MVAC with growth factor support ** |
Alternative: gemcitabine + cisplatin |
|||
Neoadjuvant Therapy
** capecitabine **
Subsequent Therapy
** DD-MVAC with growth factor support **