Skip to main content

Advertisement

SpringerLink
Log in

Treatment Approaches for Cisplatin-Ineligible Patients with Invasive Bladder Cancer

  • Genitourinary Cancers (S Gupta, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Cisplatin has been established as an important agent in the neoadjuvant setting prior to radical cystectomy (RC) surgery for muscle-invasive urothelial cancer (MIUC) as well as in the unresectable or metastatic urothelial carcinoma (mUC) setting. Unfortunately, many patients in practice are felt to be “cisplatin-ineligible.” Thus, it is vital that we develop treatment approaches and novel therapeutics for this population. We evaluate therapeutic alternatives to cisplatin-based treatment. For patients undergoing RC, there is no recommended alternative to neoadjuvant cisplatin-based combination therapy, and upfront RC or clinical trials are preferable. For patients receiving “bladder-sparing” radiation, concurrent radiosensitizing chemotherapies may be used, and several trials are also underway. For cisplatin-ineligible patients with mUC who are eligible for chemotherapy, carboplatin-based or split-dose cisplatin-based regimens may be employed. Pembrolizumab and atezolizumab offer options as first-line therapy for cisplatin-ineligible patients with high PD-L1 expression. The results of trials combining checkpoint inhibitors or platinum-based chemotherapy plus PD1/PD-L1 inhibitors are eagerly awaited. For platinum or chemotherapy-ineligible patients with mUC, immune checkpoint inhibitors such as inhibitors of programmed death-1/programmed death-ligand 1 (PD-1/PD-L1) are approved regardless of PD-L1 expression. However, given limited effectiveness of first-line PD-1/PD-L1 inhibitor monotherapy in tumors with low PD-L1 expression, trials in this space are critical.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Antoni S, Ferlay J, Soerjomataram I, Znaor A, Jemal A, Bray F. Bladder cancer incidence and mortality: a global overview and recent trends. Eur Urol. 2017;71(1):96–108. https://doi.org/10.1016/j.eururo.2016.06.010.

    Article  PubMed  Google Scholar 

  2. Cumberbatch MG, Rota M, Catto JW, La Vecchia C. The role of tobacco smoke in bladder and kidney carcinogenesis: a comparison of exposures and meta-analysis of incidence and mortality risks. Eur Urol. 2016;70(3):458–66.

    Article  CAS  Google Scholar 

  3. Freedman ND, Silverman DT, Hollenbeck AR, Schatzkin A, Abnet CC. Association between smoking and risk of bladder cancer among men and women. JAMA. 2011;306(7):737–45.

    Article  CAS  Google Scholar 

  4. Park S, Jee SH, Shin H-R, Park EH, Shin A, Jung K-W, et al. Attributable fraction of tobacco smoking on cancer using population-based nationwide cancer incidence and mortality data in Korea. BMC Cancer. 2014;14(1):406.

    Article  Google Scholar 

  5. Agudo A, Bonet C, Travier N, González CA, Vineis P, Bueno-de-Mesquita HB, et al. Impact of cigarette smoking on cancer risk in the European prospective investigation into cancer and nutrition study. J Clin Oncol. 2012;30(36):4550–7.

    Article  Google Scholar 

  6. Galsky M, Chen G, Oh W, Bellmunt J, Roth B, Petrioli R, et al. Comparative effectiveness of cisplatin-based and carboplatin-based chemotherapy for treatment of advanced urothelial carcinoma. Ann Oncol. 2011;23(2):406–10.

    Article  Google Scholar 

  7. Sonpavde G, Galsky MD, Latini D, Chen GJ. Cisplatin-ineligible and chemotherapy-ineligible patients should be the focus of new drug development in patients with advanced bladder cancer. Clin Genitourin Cancer. 2014;12(2):71–3. https://doi.org/10.1016/j.clgc.2013.11.016.

    Article  PubMed  Google Scholar 

  8. Bamias A, Tzannis K, Harshman LC, Crabb SJ, Wong YN, Kumar Pal S, et al. Impact of contemporary patterns of chemotherapy utilization on survival in patients with advanced cancer of the urinary tract: a Retrospective International Study of Invasive/Advanced Cancer of the Urothelium (RISC). Ann Oncol. 2018;29(2):361–9. https://doi.org/10.1093/annonc/mdx692.

    Article  CAS  PubMed  Google Scholar 

  9. de Wit R. Overview of bladder cancer trials in the European Organization for Research and Treatment. Cancer: Interdisciplinary International Journal of the American Cancer Society. 2003;97(S8):2120–6.

    Article  Google Scholar 

  10. Galsky MD, Hahn NM, Rosenberg J, Sonpavde G, Hutson T, Oh WK, et al. A consensus definition of patients with metastatic urothelial carcinoma who are unfit for cisplatin-based chemotherapy. Lancet Oncol. 2011;12(3):211–4. https://doi.org/10.1016/s1470-2045(10)70275-8.

    Article  PubMed  Google Scholar 

  11. Galsky MD, Hahn NM, Rosenberg J, Sonpavde G, Hutson T, Oh WK, et al. Treatment of patients with metastatic urothelial cancer “unfit” for cisplatin-based chemotherapy. J Clin Oncol. 2011;29(17):2432–8. https://doi.org/10.1200/JCO.2011.34.8433.

    Article  PubMed  Google Scholar 

  12. Lichtman SM, Buchholtz M, Marino J, Schulman P, Allen SL, Weiselberg L, et al. Use of cisplatin for elderly patients. Age Ageing. 1992;21(3):202–4.

    Article  CAS  Google Scholar 

  13. Bajorin DF, Dodd PM, Mazumdar M, Fazzari M, McCaffrey JA, Scher HI, et al. Long-term survival in metastatic transitional-cell carcinoma and prognostic factors predicting outcome of therapy. J Clin Oncol. 1999;17(10):3173–81.

    Article  CAS  Google Scholar 

  14. Saxman SB, Propert KJ, Einhorn LH, Crawford ED, Tannock I, Raghavan D, et al. Long-term follow-up of a phase III intergroup study of cisplatin alone or in combination with methotrexate, vinblastine, and doxorubicin in patients with metastatic urothelial carcinoma: a cooperative group study. J Clin Oncol. 1997;15(7):2564–9.

    Article  CAS  Google Scholar 

  15. Dash A, Galsky MD, Vickers AJ, Serio AM, Koppie TM, Dalbagni G, et al. Impact of renal impairment on eligibility for adjuvant cisplatin-based chemotherapy in patients with urothelial carcinoma of the bladder. Cancer. 2006;107(3):506–13.

    Article  CAS  Google Scholar 

  16. Lichtman SM, Wildiers H, Launay-Vacher V, Steer C, Chatelut E, Aapro M. International Society of Geriatric Oncology (SIOG) recommendations for the adjustment of dosing in elderly cancer patients with renal insufficiency. Eur J Cancer. 2007;43(1):14–34.

    Article  Google Scholar 

  17. Tsao CK, Moshier E, Seng SM, Godbold J, Grossman S, Winston J, et al. Impact of the CKD-EPI equation for estimating renal function on eligibility for cisplatin-based chemotherapy in patients with urothelial cancer. Clin Genitourin Cancer. 2012;10(1):15–20. https://doi.org/10.1016/j.clgc.2011.10.004.

    Article  PubMed  Google Scholar 

  18. Motwani SS, McMahon GM, Humphreys BD, Partridge AH, Waikar SS, Curhan GC. Development and validation of a risk prediction model for acute kidney injury after the first course of cisplatin. J Clin Oncol. 2018;36(7):682–8.

    Article  CAS  Google Scholar 

  19. Koshkin VS, Barata PC, Rybicki LA, Zahoor H, Almassi N, Redden AM, et al. Feasibility of cisplatin-based neoadjuvant chemotherapy in muscle-invasive bladder cancer patients with diminished renal function. Clin Genitourin Cancer. 2018;16:e879–92. https://doi.org/10.1016/j.clgc.2018.02.002.

    Article  PubMed  Google Scholar 

  20. Abdelhafez M, Williams M. Safety and efficacy gemcitabine-cisplatin split dose as a neoaduvant chemotherapy for muscle invasive bladder cancer. J Urol. 2017;197(4):e1194. https://doi.org/10.1016/j.juro.2017.02.2776.

    Article  Google Scholar 

  21. Hussain SA, Palmer DH, Lloyd B, Collins SI, Barton D, Ansari J, et al. A study of split-dose cisplatin-based neo-adjuvant chemotherapy in muscle-invasive bladder cancer. Oncol Lett. 2012;3(4):855–9. https://doi.org/10.3892/ol.2012.563.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Morales-Barrera R, Bellmunt J, Suarez C, Valverde C, Guix M, Serrano C, et al. Cisplatin and gemcitabine administered every two weeks in patients with locally advanced or metastatic urothelial carcinoma and impaired renal function. Eur J Cancer. 2012;48(12):1816–21. https://doi.org/10.1016/j.ejca.2012.04.002.

    Article  CAS  PubMed  Google Scholar 

  23. Kim YR, Lee JL, You D, Jeong IG, Song C, Hong B, et al. Gemcitabine plus split-dose cisplatin could be a promising alternative to gemcitabine plus carboplatin for cisplatin-unfit patients with advanced urothelial carcinoma. Cancer Chemother Pharmacol. 2015;76(1):141–53. https://doi.org/10.1007/s00280-015-2774-z.

    Article  CAS  PubMed  Google Scholar 

  24. Hussain SA, Stocken DD, Riley P, Palmer DH, Peake DR, Geh JI, et al. A phase I/II study of gemcitabine and fractionated cisplatin in an outpatient setting using a 21-day schedule in patients with advanced and metastatic bladder cancer. Br J Cancer. 2004;91(5):844–9. https://doi.org/10.1038/sj.bjc.6602112.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Mertens LS, Meijer RP, Kerst JM, Bergman AM, van Tinteren H, van Rhijn BW, et al. Carboplatin based induction chemotherapy for nonorgan confined bladder cancer--a reasonable alternative for cisplatin unfit patients? J Urol. 2012;188(4):1108–13. https://doi.org/10.1016/j.juro.2012.06.018.

    Article  CAS  PubMed  Google Scholar 

  26. Koie T, Ohyama C, Hashimoto Y, Hatakeyama S, Yamamoto H, Yoneyama T, et al. Efficacies and safety of neoadjuvant gemcitabine plus carboplatin followed by immediate cystectomy in patients with muscle-invasive bladder cancer, including those unfit for cisplatin: a prospective single-arm study. Int J Clin Oncol. 2013;18(4):724–30. https://doi.org/10.1007/s10147-012-0447-z.

    Article  CAS  PubMed  Google Scholar 

  27. Koie T, Ohyama C, Yamamoto H, Imai A, Hatakeyama S, Yoneyama T, et al. Neoadjuvant gemcitabine and carboplatin followed by immediate cystectomy may be associated with a survival benefit in patients with clinical T2 bladder cancer. Med Oncol. 2014;31(5):949. https://doi.org/10.1007/s12032-014-0949-9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Lehmann J, Kuehn M, Fischer C, Volkmer B, von Rundstedt F, Albers P et al. Randomized phase III study of adjuvant versus progression-triggered treatment with gemcitabine (G) after radical cystectomy (RC) for locally advanced bladder cancer (LABC) in patients not suitable for cisplatin-based chemotherapy (CBC)(AUO-trial AB22/00). American Society of Clinical Oncology; 2013.

  29. Spiess PE, Agarwal N, Bangs R, Boorjian SA, Buyyounouski MK, Clark PE, et al. Bladder cancer, version 5.2017, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw. 2017;15(10):1240–67. https://doi.org/10.6004/jnccn.2017.0156.

    Article  Google Scholar 

  30. Birtle AJ, Chester JD, Jones RJ, Johnson M, Hill M, Bryan RT et al. Results of POUT: a phase III randomised trial of perioperative chemotherapy versus surveillance in upper tract urothelial cancer (UTUC). American Society of Clinical Oncology; 2018.

  31. Rodel C, Grabenbauer GG, Kuhn R, Papadopoulos T, Dunst J, Meyer M, et al. Combined-modality treatment and selective organ preservation in invasive bladder cancer: long-term results. J Clin Oncol. 2002;20(14):3061–71. https://doi.org/10.1200/JCO.2002.11.027.

    Article  PubMed  Google Scholar 

  32. James ND, Hussain SA, Hall E, Jenkins P, Tremlett J, Rawlings C, et al. Radiotherapy with or without chemotherapy in muscle-invasive bladder cancer. N Engl J Med. 2012;366(16):1477–88.

    Article  CAS  Google Scholar 

  33. Choudhury A, Swindell R, Logue JP, Elliott PA, Livsey JE, Wise M, et al. Phase II study of conformal hypofractionated radiotherapy with concurrent gemcitabine in muscle-invasive bladder cancer. J Clin Oncol. 2011;29(6):733–8. https://doi.org/10.1200/JCO.2010.31.5721.

    Article  PubMed  Google Scholar 

  34. Raabe N, FOSSÅ SD, Parø G. Phase II study of carboplatin in locally advanced and metastatic transitional cell carcinoma of the urinary bladder. Br J Urol. 1989;64(6):604–7.

    Article  CAS  Google Scholar 

  35. Galsky MD, Iasonos A, Mironov S, Scattergood J, Boyle MG, Bajorin DF. Phase II trial of dose-dense doxorubicin plus gemcitabine followed by paclitaxel plus carboplatin in patients with advanced urothelial carcinoma and impaired renal function. Cancer. 2007;109(3):549–55. https://doi.org/10.1002/cncr.22454.

    Article  CAS  PubMed  Google Scholar 

  36. Petrioli R, Frediani B, Manganelli A, Barbanti G, De Capua B, De Lauretis A, et al. Comparison between a cisplatin-containing regimen and a carboplatin-containing regimen for recurrent or metastatic bladder cancer patients. A randomized phase II study. Cancer. 1996;77(2):344–51. https://doi.org/10.1002/(sici)1097-0142(19960115)77:2<344::aid-cncr18>3.0.co;2-1.

    Article  CAS  PubMed  Google Scholar 

  37. Bellmunt J, Ribas A, Eres N, Albanell J, Almanza C, Bermejo B, et al. Carboplatin-based versus cisplatin-based chemotherapy in the treatment of surgically incurable advanced bladder carcinoma. Cancer: Interdisciplinary International Journal of the American Cancer Society. 1997;80(10):1966–72.

    Article  CAS  Google Scholar 

  38. De Santis M, Bellmunt J, Mead G, Kerst JM, Leahy M, Maroto P, et al. Randomized phase II/III trial assessing gemcitabine/carboplatin and methotrexate/carboplatin/vinblastine in patients with advanced urothelial cancer who are unfit for cisplatin-based chemotherapy: EORTC study 30986. J Clin Oncol. 2012;30(2):191–9. https://doi.org/10.1200/JCO.2011.37.3571.

    Article  CAS  PubMed  Google Scholar 

  39. Dogliotti L, Carteni G, Siena S, Bertetto O, Martoni A, Bono A, et al. Gemcitabine plus cisplatin versus gemcitabine plus carboplatin as first-line chemotherapy in advanced transitional cell carcinoma of the urothelium: results of a randomized phase 2 trial. Eur Urol. 2007;52(1):134–41. https://doi.org/10.1016/j.eururo.2006.12.029.

    Article  CAS  PubMed  Google Scholar 

  40. Loehrer PJ Sr, Einhorn LH, Elson PJ, Crawford ED, Kuebler P, Tannock I, et al. A randomized comparison of cisplatin alone or in combination with methotrexate, vinblastine, and doxorubicin in patients with metastatic urothelial carcinoma: a cooperative group study. J Clin Oncol. 1992;10(7):1066–73. https://doi.org/10.1200/jco.1992.10.7.1066.

    Article  PubMed  Google Scholar 

  41. Dreicer R, Manola J, Roth BJ, See WA, Kuross S, Edelman MJ, et al. Phase III trial of methotrexate, vinblastine, doxorubicin, and cisplatin versus carboplatin and paclitaxel in patients with advanced carcinoma of the urothelium. Cancer. 2004;100(8):1639–45. https://doi.org/10.1002/cncr.20123.

    Article  CAS  PubMed  Google Scholar 

  42. Galsky MD, Chen GJ, Oh WK, Bellmunt J, Roth BJ, Petrioli R, et al. Comparative effectiveness of cisplatin-based and carboplatin-based chemotherapy for treatment of advanced urothelial carcinoma. Ann Oncol. 2012;23(2):406–10. https://doi.org/10.1093/annonc/mdr156.

    Article  CAS  PubMed  Google Scholar 

  43. Culine S, Flechon A, Guillot A, Le Moulec S, Pouessel D, Rolland F, et al. Gemcitabine or gemcitabine plus oxaliplatin in the first-line treatment of patients with advanced transitional cell carcinoma of the urothelium unfit for cisplatin-based chemotherapy: a randomized phase 2 study of the French Genitourinary Tumor Group (GETUG V01). Eur Urol. 2011;60(6):1251–7. https://doi.org/10.1016/j.eururo.2011.08.072.

    Article  CAS  PubMed  Google Scholar 

  44. Theodore C, Bidault F, Bouvet-Forteau N, Abdelatif M, Fizazi K, di Palma M, et al. A phase II monocentric study of oxaliplatin in combination with gemcitabine (GEMOX) in patients with advanced/metastatic transitional cell carcinoma (TCC) of the urothelial tract. Ann Oncol. 2006;17(6):990–4. https://doi.org/10.1093/annonc/mdl057.

    Article  CAS  PubMed  Google Scholar 

  45. Necchi A, Pond GR, Raggi D, Giannatempo P, Vogelzang NJ, Grivas P, et al. Efficacy and safety of gemcitabine plus either taxane or carboplatin in the first-line setting of metastatic urothelial carcinoma: a systematic review and meta-analysis. Clin Genitourin Cancer. 2017;15(1):23–30 e2. https://doi.org/10.1016/j.clgc.2016.05.003.

    Article  PubMed  Google Scholar 

  46. Balar AV, Galsky MD, Rosenberg JE, Powles T, Petrylak DP, Bellmunt J, et al. Atezolizumab as first-line treatment in cisplatin-ineligible patients with locally advanced and metastatic urothelial carcinoma: a single-arm, multicentre, phase 2 trial. Lancet. 2017;389(10064):67–76. https://doi.org/10.1016/s0140-6736(16)32455-2.

    Article  CAS  PubMed  Google Scholar 

  47. Balar AV, Castellano D, O'Donnell PH, Grivas P, Vuky J, Powles T, et al. First-line pembrolizumab in cisplatin-ineligible patients with locally advanced and unresectable or metastatic urothelial cancer (KEYNOTE-052): a multicentre, single-arm, phase 2 study. Lancet Oncol. 2017;18(11):1483–92. https://doi.org/10.1016/s1470-2045(17)30616-2.

    Article  CAS  PubMed  Google Scholar 

  48. Bellmunt J, de Wit R, Vaughn DJ, Fradet Y, Lee JL, Fong L, et al. Pembrolizumab as second-line therapy for advanced urothelial carcinoma. N Engl J Med. 2017;376(11):1015–26. https://doi.org/10.1056/NEJMoa1613683 This pivotal randomized trial established an overall survival benefit of pembrolizumab and resulted in pembrolizumab being the preferred second-line therapy for advanced bladder cancer in lieu of chemotherapy.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Vaughn DJ, Bellmunt J, Fradet Y, Lee JL, Fong L, Vogelzang NJ, et al. Health-related quality-of-life analysis from KEYNOTE-045: a phase III study of pembrolizumab versus chemotherapy for previously treated advanced urothelial cancer. J Clin Oncol. 2018;36(16):1579–87. https://doi.org/10.1200/jco.2017.76.9562.

    Article  CAS  PubMed  Google Scholar 

  50. Sharma P, Retz M, Siefker-Radtke A, Baron A, Necchi A, Bedke J, et al. Nivolumab in metastatic urothelial carcinoma after platinum therapy (CheckMate 275): a multicentre, single-arm, phase 2 trial. Lancet Oncol. 2017;18(3):312–22. https://doi.org/10.1016/s1470-2045(17)30065-7 This trial established the effectiveness of nivolumab as second-line therapy for metastatic urothelial carcinoma.

    Article  CAS  PubMed  Google Scholar 

  51. Patel MR, Ellerton J, Infante JR, Agrawal M, Gordon M, Aljumaily R, et al. Avelumab in metastatic urothelial carcinoma after platinum failure (JAVELIN solid tumor): pooled results from two expansion cohorts of an open-label, phase 1 trial. Lancet Oncol. 2018;19(1):51–64. https://doi.org/10.1016/s1470-2045(17)30900-2This trial established the effectiveness of avelumab as second-line therapy for metastatic urothelial carcinoma.

    Article  CAS  PubMed  Google Scholar 

  52. Powles T, O’donnell PH, Massard C, Arkenau H-T, Friedlander TW, Hoimes CJ, et al. Efficacy and safety of durvalumab in locally advanced or metastatic urothelial carcinoma: updated results from a phase 1/2 open-label study. JAMA Oncol. 2017;3(9):e172411–e This trial established the efficacy of durvalumab in advanced or metastatic urothelial carcinoma.

    Article  Google Scholar 

  53. Powles T, Gschwend JE, Loriot Y, Bellmunt J, Geczi L, Vulsteke C et al. Phase 3 KEYNOTE-361 trial: Pembrolizumab (pembro) with or without chemotherapy versus chemotherapy alone in advanced urothelial cancer. American Society of Clinical Oncology; 2017.

  54. Galsky MD, Grande E, Davis ID, De Santis M, Arranz Arija JA, Kikuchi E et al. IMvigor130: a randomized, phase III study evaluating first-line (1L) atezolizumab (atezo) as monotherapy and in combination with platinum-based chemotherapy (chemo) in patients (pts) with locally advanced or metastatic urothelial carcinoma (mUC). American Society of Clinical Oncology; 2018.

  55. Necchi A, Anichini A, Raggi D, Briganti A, Massa S, Lucianò R et al. Pembrolizumab as neoadjuvant therapy before radical cystectomy in patients with muscle-invasive urothelial bladder carcinoma (PURE-01): an open-label, single-arm, phase II study. J Clin Oncol. This recent single-arm study demonstrated a substantial rate of pathologic complete response after neoadjuvant pembrolizumab followed by cystectomy. 2018:JCO. 18.01148.

  56. Powles T, Rodriguez-Vida A, Duran I, Crabb SJ, Van Der Heijden MS, Font Pous A et al. A phase II study investigating the safety and efficacy of neoadjuvant atezolizumab in muscle invasive bladder cancer (ABACUS). American Society of Clinical Oncology; 2018.

  57. Hoimes CJ, Abouassaly R, Saltzman JN, Fleming MT, Hoffman-Censits JH, Byrd T, et al. HCRN GU14-188: Neoadjuvant pembrolizumab (P) and gemcitabine (G) with or without cisplatin (C) in muscle invasive urothelial cancer (MIUC). J Clin Oncol. 2016;34(15_suppl):TPS4578–TPS. https://doi.org/10.1200/JCO.2016.34.15_suppl.TPS4578.

    Article  Google Scholar 

  58. Sonpavde G, Galsky MD, Vogelzang NJ. First-line systemic therapy trials for advanced transitional-cell carcinoma of the urothelium: should we stop separating cisplatin-eligible and -ineligible patients? J Clin Oncol. 2010;28(25):e441–e2. https://doi.org/10.1200/jco.2010.29.1047.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA

    David J. Einstein MD

  2. Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, DANA 1230, Boston, MA, 02215, USA

    Guru Sonpavde MD

Authors
  1. David J. Einstein MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Guru Sonpavde MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Guru Sonpavde MD.

Ethics declarations

Conflict of Interest

David J. Einstein has received research funding (paid to Beth Israel Deaconess Medical Center, Boston, MA) for clinical trials from Bristol-Myers Squibb and TrovaGene.

Guru Sonpavde has received research funding (paid to Dana-Farber Cancer Institute, Boston, MA) for clinical trials from Boehringer Ingelheim, Bayer, Onyx-Amgen, Pfizer, Merck, Sanofi, Janssen, and Celgene; has received compensation for service as a consultant from Pfizer, Genentech, Novartis, Merck, Sanofi, Agensys/Astellas, AstraZeneca, Biotheranostics, Exelixis, Bristol-Myers Squibb, Janssen, Amgen, Eisai, and the National Comprehensive Cancer Network; has received CME lecture fees from Clinical Care Options; has received speaker’s honoraria from Physicians Education Resource, OncLive, and Research to Practice; has been a member of the data safety monitoring board of a trial funded by AstraZeneca; and has received honoraria from UpToDate for authorship of an education chapter/review.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article part of the Topical Collection on Genitourinary Cancers

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Einstein, D.J., Sonpavde, G. Treatment Approaches for Cisplatin-Ineligible Patients with Invasive Bladder Cancer. Curr. Treat. Options in Oncol. 20, 12 (2019). https://doi.org/10.1007/s11864-019-0609-6

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11864-019-0609-6

Keywords

Search

Navigation