Clinical and Translational Oncology

, Volume 21, Issue 3, pp 280–288 | Cite as

Beyond first-line systemic treatment for metastatic urothelial carcinoma of the bladder

  • E. El Rassy
  • T. AssiEmail author
  • Z. Bakouny
  • N. Pavlidis
  • J. Kattan
Review Article


Metastatic urothelial carcinoma of the bladder is a rarely curable disease. Patients receive systemic therapy with limited response rates and survival benefits. The rescue regimens of these patients who have failed first-line treatment had remained problematic until the recent advances. Several trials with novel regimens, including immune checkpoint inhibitors and targeted therapy, to salvage relapsed urothelial carcinoma of the bladder have recently been published. However, the choice of an optimal treatment regimen remains challenging in the absence of randomized trials comparing regimen sequences. Daily clinical cases provoke the question of whether there is a preferred second-line regimen. This paper provides an overview of recent trials and proposes a management algorithm based on subgroup analyses and prognostic features.


Urothelial bladder cancer Second-line Chemotherapy Immune checkpoint inhibitor Targeted therapy 



Metastatic urothelial carcinoma of the bladder


Gemcitabine plus cisplatin


Methotrexate, vinblastine, doxorubicin and cisplatin


Overall response rate


Progression free survival


Overall survival


Immune checkpoint inhibitor


Food and drug administration


European Medicines Agency


Hazard ratio

95% CI

95% confidence interval


Quality of life


Compliance with Ethical Standards

Conflict of interest

The authors declares that they have no conflict of interest.

Ethical approval

An approval of the institutional ethics board of the Faculty of Medicine of Saint Joseph University was obtained.

Research involving human participants and/or animals


Informed consent



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Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2018

Authors and Affiliations

  1. 1.Department of Medical Oncology, Faculty of Medicine, Hotel Dieu de France University HospitalSaint Joseph UniversityBeirutLebanon
  2. 2.Department of Medical Oncology, Institut Gustave RoussyUniversité Paris-SaclayVillejuifFrance
  3. 3.University of IoanninaIoanninaGreece

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