TY - CHAP M1 - Book, Section TI - Bladder Cancer A1 - Andreev-Drakhlin, Alexander Y. A1 - Kamat, Ashish M. A1 - Siefker-Radtke, Arlene O. A2 - Kantarjian, Hagop M. A2 - Wolff, Robert A. A2 - Rieber, Alyssa G. PY - 2022 T2 - The MD Anderson Manual of Medical Oncology, 4e AB - KEY CONCEPTSPembrolizumab has recently been approved for patients with Bacillus Calmette-Guerin (BCG)-unresponsive non–muscle-invasive urothelial cancer based on responses observed in a cohort of patients with carcinoma in situ in their bladders.Neoadjuvant cisplatin-based chemotherapy remains the standard of care treatment for muscle-invasive bladder cancer. Dose-dense MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) has largely supplanted traditional MVAC because of its improved toxicity profile and shorter time to surgery.Immune checkpoint inhibitors have been approved frontline treatment for patients with metastatic urothelial cancer who are not eligible for cisplatin-based chemotherapy. Programmed cell death ligand 1 (PD-L1) expression is required in this setting.Immune checkpoint inhibitors are also approved after chemotherapy with level 1 evidence showing a survival benefit with pembrolizumab in the second-line setting and with avelumab in the maintenance setting in patients with stable disease or better for frontline chemotherapy. At the moment, there is no definitive evidence as to whether maintenance checkpoint inhibition or checkpoint inhibition at progression is the optimal treatment strategy. PD-L1 expression is not needed in the postchemotherapy setting.In April 2019, the Food and Drug Administration (FDA) granted accelerated approval to erdafitinib, the first-in-class fibroblast growth factor receptor 3 (FGFR3) inhibitor based on efficacy in the second-line setting. FGFR3 mutations or fusions are required for treatment.In December 2019, the FDA granted accelerated approval to enfortumab vedotin, the first antibody–drug conjugate approved for urothelial cancer based on efficacy in the third-line setting (postchemotherapy, postimmunotherapy). This antibody targets nectin-4, which is highly expressed in urothelial cancer, so expression levels are not necessary. SN - PB - McGraw Hill Education CY - New York, NY Y2 - 2024/10/04 UR - hemonc.mhmedical.com/content.aspx?aid=1190837670 ER -