Immunotherapy for Bladder Cancer
All of the treatment op ons shown may be appropriate. The selec on of therapy
should be individualized based on pa ent eligibility and the availability of therapy, at
the discre on of the trea ng physician.
(1) Atezolizumab and pembrolizumab are FDA approved for pa ents with metasta c
urothelial carcinoma who are ineligible to receive cispla n and are recommended
for first-line treatment.
Pembrolizumab is appropriate for pa ents with MSI-H tumors that have
progressed following prior treatment, with no sa sfactory alterna ves.
(2) Atezolizumab, nivolumab, durvalumab, avelumab, and pembrolizumab are
FDA approved for advanced disease that has worsened on pla num-containing
regimens or within 12 months of receiving a pla num-containing regimen before
(neoadjuvant) or a er surgery (adjuvant).
• Pa ent and disease reviewed by mul disciplinary team
• Staging confirmed including pathology and imaging
Diagnos
c
Workup
Pa
ent
Selec
on
Treatment
Recommenda
ons
Cispla n eligible Cispla n ineligible
Gemcitabine
and cispla n OR
DDMVAC with
growth factor
support
Gemcitabine and
carbopla n OR
other non-cispla n
combina ons
Atezolizumab / nivolumab /
durvalumab / avelumab /
pembrolizumab
Atezolizumab /
pembrolizumab
Paclitaxel / docetaxel /
other cytotoxic
chemotherapy
1
2
If no prior treatment with
a checkpoint inhibitor
Figure 2. Treatment Algorithm for Locally Advanced or
Metasta c Bladder Cancer
