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Information

Adjuvant Therapy

Single-Agent Regimens

Nivolumab

Nivolumab:

240 mg IV day on 1

Repeat cycle every 2 weeks for up to 1 year [37].

Advanced Disease

Combination Regimens

ITP

Ifosfamide:

1,500 mg/m2 IV on days 1-3

Paclitaxel:

200 mg/m2 IV over 3 hours on day 1

Cisplatin:

70 mg/m2 IV on day 1

Repeat cycle every 21 days [38]. G-CSF support is recommended. Regimen can also be administered every 28 days.

Dose-Dense Gemcitabine + Cisplatin

Gemcitabine:

2,500 mg/m2 IV on day 1

Cisplatin:

35 mg/m2 IV on days 1 and 2

Repeat cycle every 14 days for up to 6 cycles [39].

Gemcitabine + Cisplatin

Gemcitabine:

1,000 mg/m2 IV on days 1, 8, and 15

Cisplatin:

75 mg/m2 IV on day 1

Repeat cycle every 28 days [40].

Gemcitabine + Carboplatin

Gemcitabine:

1,000 mg/m2 IV on days 1 and 8

Carboplatin:

AUC of 4, IV on day 1

Repeat cycle every 21 days up to 6 cycles [41].

Gemcitabine + Paclitaxel

Gemcitabine:

1,000 mg/m2 IV on days 1, 8, and 15

Paclitaxel:

200 mg/m2 IV on day 1

Repeat cycle every 21 days [42].

or

Gemcitabine:

2,500 mg/m2 IV on day 1

Paclitaxel:

150 mg/m2 IV on day 1

Repeat cycle every 14 days [43].

Gemcitabine + Docetaxel

Gemcitabine:

1,000 mg/m2 IV on days 1, 8, and 15

Docetaxel:

60 mg/m2 IV on day 1

Repeat cycle every 28 days [44].

Dose-Dense MVAC

Methotrexate:

30 mg/m2 IV on days 1, 15, and 22

Vinblastine:

3 mg/m2 IV on days 2, 15, and 22

Doxorubicin:

30 mg/m2 IV on day 2

Cisplatin:

70 mg/m2 IV on day 2

Repeat cycle every 28 days [45].

CMV

Cisplatin:

100 mg/m2 IV on day 2 (give 12 hours after methotrexate)

Methotrexate:

30 mg/m2 IV on days 1 and 8

Vinblastine:

4 mg/m2 IV on days 1 and 8

Repeat cycle every 21 days [46].

MCV

Methotrexate:

30 mg/m2 IV on days 1, 15, and 22

Carboplatin:

AUC of 4.5, IV on day 1

Vinblastine:

3 mg/m2 IV on days 1, 15, and 22

Repeat cycle every 28 days [47].

Docetaxel + Cisplatin

Docetaxel:

75 mg/m2 IV on day 1

Cisplatin:

75 mg/m2 IV on day 1

Repeat cycle every 21 days up to 6 cycles [48].

Paclitaxel + Carboplatin

Paclitaxel:

225 mg/m2 IV over 3 hours on day 1

Carboplatin:

AUC of 6, IV on day 1, given 15 minutes after paclitaxel

Repeat cycle every 21 days [49].

CAP

Cyclophosphamide:

400 mg/m2 IV on day 1

Doxorubicin:

40 mg/m2 IV on day 1

Cisplatin:

75 mg/m2 IV on day 2

Repeat cycle every 21 days [50].

5-Fluorouracil + Mitomycin-C + Radiation Therapy

5-Fluorouracil:

500 mg/m2/day IV continuous infusion on days 1-5 and 16-20 of radiotherapy

Mitomycin-C:

12 mg/m2 IV on day 1

Radiation therapy 275 cGy/day, 5 days/week for a total of 4 weeks (total dose, 5,500 cGy) or 200 cGy/day for 6.5 weeks (total dose, 6,400 cGy)

Chemotherapy is given concurrently with radiation therapy [51].

Enfortumab vedotin + Pembrolizumab

Enfortumab vedotin:

1.25 mg/kg (up to maximum of 125 mg) IV on days 1, 8, and 15

Pembrolizumab:

200 mg IV on day 1

Repeat cycle every 21 days [52].

Single-Agent Regimens

Gemcitabine

Gemcitabine:

1,200 mg/m2 IV on days 1, 8, and 15

Repeat cycle every 28 days [53].

Paclitaxel

Paclitaxel:

250 mg/m2 IV over 24 hours on day 1

Repeat cycle every 21 days [54].

or

Paclitaxel:

80 mg/m2 IV weekly for 3 weeks

Repeat cycle every 4 weeks [55].

Pemetrexed

Pemetrexed:

500 mg/m2 IV on day 1

Repeat cycle every 21 days [56]. Folic acid at 350-1,000 μg PO daily beginning 1-2 weeks prior to therapy and vitamin B12 at 1,000 μg IM to start 1-2 weeks prior to first dose of therapy and repeated every 3 cycles.

Atezolizumab

Atezolizumab:

1,200 mg IV on day 1

Repeat cycle every 21 days [57].

Avelumab

Avelumab:

10 mg/kg IV on day 1

Repeat cycle every 14 days [58].

Durvalumab

Durvalumab:

10 mg/kg IV on day 1

Repeat cycle every 14 days [59].

Nivolumab

Nivolumab:

240 mg IV on day 1

Repeat cycle every 14 days [60]. May also administer 480 mg IV on day 1 with cycles repeated every 28 days.

Pembrolizumab

Pembrolizumab:

200 mg IV on day 1

Repeat cycle every 21 days [61]. May also administer 400 mg IV every 6 weeks.

Erdafitinib

Erdafitinib:

8 mg PO daily

Continue treatment until disease progression [62]. Increase dose to 9 mg daily if serum phosphate level <5.5 mg/dL, and there are no ocular disorders or grade ≥2 adverse events.

Enfortumab vedotin-ejfv

Enfortumab vedotin-ejfv:

1.25 mg/kg IV on days 1, 8, and 15

Repeat cycle every 28 days [63].

Sacituzumab govitecan

Sacituzumab govitecan:

10 mg/kg IV on days 1 and 8

Repeat cycle every 28 days [64].

Mitomycin

Mitomycin:

Instill 4 mg/mL via ureteral catheter or nephrostomy tube with total instillation volume not to exceed 15 mL (60 mg)

Instill once weekly for 6 weeks [65]. For patients with a complete response 3 months after initiation of therapy, mitomycin instillations may be administered once a month for a maximum of 11 additional instillations.

Nadofaragene

Nadofaragene:

Instill 75 mL (3 x 1011 viral particles/mL) via ureteral catheter

Instill once every 3 months for up to 12 months [66].