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On April 23-24, 2021, the Chinese Society of Clinical Oncology (CSCO) Guidelines Conference was successfully held in Beijing, the capital.
As one of the most influential academic festivals in the field of oncology in China, big coffees from all over the country gathered together to witness the update of multiple guidelines.
In the urinary system tumor special session on the afternoon of the 23rd, Professor Cui Chuanliang from Peking University Cancer Hospital interpreted the updated points of the 2021 CSCO Urothelial Carcinoma Diagnosis and Treatment Guidelines.
01 Adjuvant treatment for muscular invasive bladder cancer after operation.
Adjuvant treatment for muscular invasive bladder cancer.
For patients with muscular invasive bladder cancer, a comprehensive treatment plan of transurethral bladder tumor resection combined with postoperative radiotherapy and chemotherapy is available and standard Radical bladder cancer surgery has similar 10-year overall survival rate and progression-free survival rate; it can be used as a treatment option for patients who are not suitable or who refuse to undergo cystectomy.
For patients with poor surgical margins and late local lesions, and only undergoing palliative surgery, postoperative radiotherapy can improve the local control rate.
For patients with pT3/4 and/or lymph node positive and no distant metastasis (M0), adjuvant chemotherapy after radical cystectomy is still controversial.
Based on the CheckMate-274 study reaching the primary research endpoint, in 2021 CSCO urothelial cancer plans to increase the postoperative adjuvant treatment of PD-1 monoclonal antibody as a grade III recommendation.
02 First-line treatment of metastatic urothelial cancer Table first-line treatment Currently, chemotherapy is still the basis for the treatment of urothelial cancer.
Based on the IMvigor210 study and the KEYNOTE-052 study, atezolizumab and pembrolizumab were approved by the FDA for the first-line treatment of platinum-intolerant metastatic urothelial cancer.
In the KEYNOTE-052 study, PD-L1 positive patients benefited more significantly.
At present, atelizumab and pembrolizumab have not yet obtained indications for the treatment of metastatic urothelial carcinoma in China, and are only suitable for patients with PD-L1 expression or who cannot tolerate platinum-based chemotherapy.
In the first-line treatment of the new CSCO guidelines for urothelial cancer, for patients with locally advanced or metastatic urothelial cancer that are not suitable for cisplatin, the level III recommendation still retains atezizumab (class 2A evidence) and pembrolizumab Monoclonal antibody (Class 2A evidence).
03Maintenance treatment after first-line treatment of metastatic urothelial cancer.
With the development of immunotherapy, the indications of maintenance treatment after first-line treatment continue to move forward.
Based on the results of the JAVELIN Bladder 100 study and the HCRN GU14-182 study, for patients with stable or objectively effective disease after 4 to 6 cycles of first-line chemotherapy, avirumumab is recommended for level II (Class 1A evidence); level III is recommended for Pascal Bolivizumab (Class 2A evidence).
Aviruzumab has not yet been marketed in China, and pembrolizumab has not yet obtained indications for advanced urothelial cancer in China.
04 Second-line treatment of advanced urothelial cancer table Second-line treatment of urothelial cancer is given priority to immunotherapy; Erdatinib has not been approved for marketing in China, and is only suitable for advanced urothelial cancer with FGFR2/3 gene mutation; Riprolizumab, pembrolizumab, and aviruzumab have not yet obtained indications for advanced urothelial cancer in China.
Because the US FDA withdrew the indications of atilizumab and duvalizumab for the second-line treatment of urothelial cancer.
This year's CSCO guidelines also removed Level III recommendations.
Based on the results of BGB-A317-204 and POLARIS-03, the new CSCO guidelines continue to recommend tislelizumab (class 2A evidence) (only applicable to locally advanced or metastatic urothelial cancer with high PD-L1 expression), Teriplizumab (Class 2A evidence) is used for the second-line treatment of advanced urothelial cancer (Class II recommendation).
In addition, these two drugs are relatively well accessible, and both have been approved for urothelial cancer indications in China, and tislelizumab has entered medical insurance.
05 Third-line treatment for advanced urothelial cancer Table third-line treatment For patients who have failed previous platinum-based chemotherapy and immunotherapy, based on the data of the BLC2001 study, the guidelines continue to use Erdafitinib as a level III recommendation (class 2A evidence).
Patients with FGFR2/3 gene mutations; Based on the EV-301 study data, the guideline adds a new level III recommendation for the new antibody conjugate drug Enfortumab vedotin (Class 2A evidence).
Based on the results of the domestic phase II study of widisituzumab (RC48-ADC), the new version of the guidelines intends to add widisituzumab for posterior treatment (level III recommendation).
Similar to the second-line treatment, the new version of the guidelines also deletes the atilizumab and pembrolizumab regimens in the third-line treatment grade III recommendation.
As one of the most influential academic festivals in the field of oncology in China, big coffees from all over the country gathered together to witness the update of multiple guidelines.
In the urinary system tumor special session on the afternoon of the 23rd, Professor Cui Chuanliang from Peking University Cancer Hospital interpreted the updated points of the 2021 CSCO Urothelial Carcinoma Diagnosis and Treatment Guidelines.
01 Adjuvant treatment for muscular invasive bladder cancer after operation.
Adjuvant treatment for muscular invasive bladder cancer.
For patients with muscular invasive bladder cancer, a comprehensive treatment plan of transurethral bladder tumor resection combined with postoperative radiotherapy and chemotherapy is available and standard Radical bladder cancer surgery has similar 10-year overall survival rate and progression-free survival rate; it can be used as a treatment option for patients who are not suitable or who refuse to undergo cystectomy.
For patients with poor surgical margins and late local lesions, and only undergoing palliative surgery, postoperative radiotherapy can improve the local control rate.
For patients with pT3/4 and/or lymph node positive and no distant metastasis (M0), adjuvant chemotherapy after radical cystectomy is still controversial.
Based on the CheckMate-274 study reaching the primary research endpoint, in 2021 CSCO urothelial cancer plans to increase the postoperative adjuvant treatment of PD-1 monoclonal antibody as a grade III recommendation.
02 First-line treatment of metastatic urothelial cancer Table first-line treatment Currently, chemotherapy is still the basis for the treatment of urothelial cancer.
Based on the IMvigor210 study and the KEYNOTE-052 study, atezolizumab and pembrolizumab were approved by the FDA for the first-line treatment of platinum-intolerant metastatic urothelial cancer.
In the KEYNOTE-052 study, PD-L1 positive patients benefited more significantly.
At present, atelizumab and pembrolizumab have not yet obtained indications for the treatment of metastatic urothelial carcinoma in China, and are only suitable for patients with PD-L1 expression or who cannot tolerate platinum-based chemotherapy.
In the first-line treatment of the new CSCO guidelines for urothelial cancer, for patients with locally advanced or metastatic urothelial cancer that are not suitable for cisplatin, the level III recommendation still retains atezizumab (class 2A evidence) and pembrolizumab Monoclonal antibody (Class 2A evidence).
03Maintenance treatment after first-line treatment of metastatic urothelial cancer.
With the development of immunotherapy, the indications of maintenance treatment after first-line treatment continue to move forward.
Based on the results of the JAVELIN Bladder 100 study and the HCRN GU14-182 study, for patients with stable or objectively effective disease after 4 to 6 cycles of first-line chemotherapy, avirumumab is recommended for level II (Class 1A evidence); level III is recommended for Pascal Bolivizumab (Class 2A evidence).
Aviruzumab has not yet been marketed in China, and pembrolizumab has not yet obtained indications for advanced urothelial cancer in China.
04 Second-line treatment of advanced urothelial cancer table Second-line treatment of urothelial cancer is given priority to immunotherapy; Erdatinib has not been approved for marketing in China, and is only suitable for advanced urothelial cancer with FGFR2/3 gene mutation; Riprolizumab, pembrolizumab, and aviruzumab have not yet obtained indications for advanced urothelial cancer in China.
Because the US FDA withdrew the indications of atilizumab and duvalizumab for the second-line treatment of urothelial cancer.
This year's CSCO guidelines also removed Level III recommendations.
Based on the results of BGB-A317-204 and POLARIS-03, the new CSCO guidelines continue to recommend tislelizumab (class 2A evidence) (only applicable to locally advanced or metastatic urothelial cancer with high PD-L1 expression), Teriplizumab (Class 2A evidence) is used for the second-line treatment of advanced urothelial cancer (Class II recommendation).
In addition, these two drugs are relatively well accessible, and both have been approved for urothelial cancer indications in China, and tislelizumab has entered medical insurance.
05 Third-line treatment for advanced urothelial cancer Table third-line treatment For patients who have failed previous platinum-based chemotherapy and immunotherapy, based on the data of the BLC2001 study, the guidelines continue to use Erdafitinib as a level III recommendation (class 2A evidence).
Patients with FGFR2/3 gene mutations; Based on the EV-301 study data, the guideline adds a new level III recommendation for the new antibody conjugate drug Enfortumab vedotin (Class 2A evidence).
Based on the results of the domestic phase II study of widisituzumab (RC48-ADC), the new version of the guidelines intends to add widisituzumab for posterior treatment (level III recommendation).
Similar to the second-line treatment, the new version of the guidelines also deletes the atilizumab and pembrolizumab regimens in the third-line treatment grade III recommendation.
