The literature for the complete document has been assessed and updated, whenever relevant. Conclusions and recommendations have been rephrased and added to throughout the current document.
Key changes for the 2022 print can be found in:
- Section 3.1 – Epidemiology, due to the inclusion of additional data on mismatch repair testing, Figure 3.1: Selection of patients with UTUC for Lynch syndrome screening during the first medical Interview, was revised.
- Chapter 6 – Prognosis, considerable data has been added.
- Section 7.1.2 Management of high-risk non-metastatic UTUC – New Section 7.1.3.2.2 Immunotherapy, was added.
- Section 7.2.3 Systemic treatments. This section has been completely restructured and updated, resulting in a number of changes to the Summary of changes and guidelines for the treatment of metastatic UTUC.
7.2.4 Summary of evidence and guidelines for the treatment of metastatic UTUC
Summary of evidence | LE |
Cisplatin-containing combination chemotherapy is standard in advanced or metastatic patients fit enough to tolerate cisplatin. | 1b
|
Maintenance avelumab is associated with an OS advantage compared with best supportive care in patients who did not have disease progression after 4 to 6 cycles of gemcitabine plus cisplatin or carboplatin. | 1b
|
PD-1 inhibitor pembrolizumab has been approved for patients who have progressed during or after previous platinum-based chemotherapy and did not receive previous immune therapy based on the results of a phase III trial. | 1b
|
PD-L1 inhibitor atezolizumab has been approved for patients that have progressed during or after previous platinum-based chemotherapy and did not receive previous immune therapy based on the results of a phase II trial. | 2a
|
PD-1 inhibitor nivolumab has been approved for patients that have progressed during or after previous platinum-based chemotherapy and did not receive previous immune therapy based on the results of a phase II trial. | 2a
|
Erdafitinib improves OS in in platinum-refractory patients with locally advanced or metastatic UC and FGFR DNA genomic alterations (FGFR2 or 3 mutations, or FGFR3 fusions). | 2a
|
Recommendation | Strength rating |
First-line treatment for cisplatin-eligible patients | |
Use maintenance avelumab in patients who did not have disease progression after 4 to 6 cycles of gemcitabine plus cisplatin. | Strong
|
First-line treatment in patients unfit for cisplatin | |
Use maintenance avelumab in patients who did not have disease progression after 4 to 6 cycles of gemcitabine plus carboplatin. | Strong
|
Second-line treatment | |
Offer erdafitinib in platinum-refractory tumours with FGFR alterations. | Strong |
FGFR = fibroblast growth factor receptors.