Table 5

mUC treatment algorithm

Patient populationManagement
Cisplatin-eligiblePlatinum-based chemotherapyIf no disease progressionAvelumab maintenance
If disease progressionPembrolizumab
Avelumab
Nivolumab*
Cisplatin-ineligiblePD-L1-positive tumors†Atezolizumab*
Pembrolizumab*
PD-L1-negative tumors†Carboplatin-based chemotherapy
Cisplatin- and carboplatin-ineligibleAtezolizumab‡*
Pembrolizumab‡*
  • Individual rows represent treatment decision options that can be followed from left to right horizontally in adjacent columns.

  • *Accelerated approvals contingent on confirmatory trials at the time of guideline publication.

  • †As determined by the appropriate FDA-approved companion diagnostic (ie, PD-L1 staining immune cells (IC) ≥5% of the tumor area by SP142 assay for atezolizumab and combined positive score (CPS) ≥10 by IHC 22C3 assay for pembrolizumab).

  • ‡Recommendation based on US-only indication.

  • mUC, advanced/metastatic urothelial cancer; PD-L1, programmed death-ligand 1.