How would you treat a patient with biopsy-proven recurrent urothelial bladder cancer with M1a disease (limited to retroperitoneal nodal disease)?

NCCN guidelines suggest systemic therapy only or concurrent chemoradiotherapy. What is your approach?

1 Answer

Mednet MemberInvited Expert

Medical Oncology · University of Washington School of Medicine

Answered on

Systemic therapy with either clinical trial, or chemotherapy (ideally cisplatin-based or carboplatin/gemcitabine if cisplatin-unfit), or immune checkpoint inhibitor (if it is first line treatment setting and cisplatin-unfit, options include either pembrolizumab or atezolizumab, if either 'PD-L1 high' based on the corresponding companion PD-L1 assay or unfit also for carboplatin). I am worried about risk of further systemic/distant disease. If really prolonged response to systemic therapy, there may be a question of 'consolidation" local therapy with either radiation or RPLND; however, there is no high level evidence for that consolidation approach, such patients should be discussed at multi-disciplinary GU tumor boards with expertise in this cancer type, if possible.