Patient population | Management | |||
Cisplatin-eligible | Platinum-based chemotherapy | If no disease progression | Avelumab maintenance | |
If disease progression | Pembrolizumab Avelumab Nivolumab* | |||
Cisplatin-ineligible | PD-L1-positive tumors† | Atezolizumab* Pembrolizumab* | ||
PD-L1-negative tumors† | Carboplatin-based chemotherapy | |||
Cisplatin- and carboplatin-ineligible | Atezolizumab‡* 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.