Treatment protocols for bladder and urinary tract cancers

INTRODUCTION — The following material represents a subset of chemotherapy and immunotherapy regimens that are used for the treatment of patients with bladder cancer in the neoadjuvant, adjuvant, or metastatic setting. This is not an exhaustive list; it includes regimens that are considered by the authors and editors to be commonly used and important for the care of patients with bladder cancer. Additional regimens may be added over time, particularly as treatment for bladder cancer evolves.

This topic review is intended to provide only a listing of chemotherapy and immunotherapy regimens. It does not address the appropriate context for use of these regimens in the care of patients with bladder cancer. Clinicians should refer to the individual disease-oriented topic reviews that discuss the use of these protocols in appropriate clinical situations:

●(See "Neoadjuvant treatment options for muscle-invasive urothelial bladder cancer", section on 'Neoadjuvant chemotherapy'.)

●(See "Adjuvant therapy for muscle-invasive urothelial carcinoma of the bladder".)

●(See "Treatment of metastatic urothelial carcinoma of the bladder and urinary tract".)

These tables are provided as examples of how to administer these regimens; there may be other acceptable methods. All chemotherapy and immunotherapy regimens must be administered by clinicians who are trained in the use of chemotherapy and immunotherapy. The clinician is expected to use his or her independent medical judgment in the context of individual circumstances to make adjustments, as necessary.

REGIMENS

Gemcitabine plus cisplatin (GC): 28-day cycle —  (table 1)

Gemcitabine plus cisplatin (GC): 21-day cycle —  (table 2)

Paclitaxel, gemcitabine, and cisplatin (PGC) —  (table 3)

Methotrexate plus vinblastine, doxorubicin, and cisplatin (MVAC) —  (table 4)

Dose-dense methotrexate plus vinblastine, doxorubicin, and cisplatin (dose-dense MVAC) —  (table 5)

Nivolumab monotherapy —  (table 6)

Pembrolizumab monotherapy —  (table 7)

ACKNOWLEDGMENT — The UpToDate editorial staff acknowledges Scott M Wirth, PharmD, BCOP, who contributed to an earlier version of this topic review.