2021 Fifth Edition Update Highlights of the NCCN Bladder Cancer Guidelines

*Only for medical professionals to read and reference NCCN launched the fifth edition of this year's bladder cancer guidelines on October 20, 2021, and updated a number of related adjuvant therapy and first-line medication provisions
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The following provides you with the update points of the 2021 fifth edition of the NCCN guidelines: Guideline update point 1: BL-5, BL-7 revise the adjuvant treatment provisions for stages II and IIIA: ● Based on pathological risk assessment.
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In patients with pT3, pT4, or pN+ tumors treated with platinum neoadjuvant therapy: .
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◆Adjuvant cisplatin chemotherapy (preferred), or .
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◆Adjuvant nivolumab Consider use in ypT2-ypT4a or ypN+ patients who have received prior neoadjuvant chemotherapy Consider adjuvant RT with nivolumab in T3-T4, node-positive, or border-positive patients (category 2B recommendation) Footnote added: Best suited for patients who value delayed chance of recurrence and consider the risk of adverse effects to be acceptable, and accept complete disease remission The chances of patients not improving
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BL-G (1/7) neoadjuvant chemotherapy (preferred regimen for bladder cancer) Preferred course of treatment: Revised: use of DDMVAC (dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin) with growth factor support , continue for 3-6 cycles
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● 4 cycles of gemcitabine and cisplatin have been reclassified as "other recommended regimens"
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● Other recommended regimens: Added: 1 cycle of gemcitabine and cisplatin use Deleted: 3 cycles of CMV (cisplatin, methotrexate, vinblastine) ● New table: Adjuvant therapy recommendation, with addition of nivolumab Use recommended
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BL-G (2/7) patients with locally advanced or metastatic tumors who are not eligible for first-line treatment with cisplatin chemotherapy; revisions: ● Deleted pembrolizumab only for PD-L1-positive patients who were not eligible for any platinum-containing chemotherapy Recommendations for patients undergoing chemotherapy
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New recommendation: Use pembrolizumab in patients with locally advanced or metastatic tumors who are refractory to platinum-based chemotherapy
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UTT-3 Adjuvant Therapy Partial Revision: If not receiving neoadjuvant therapy and pT3, pT4, or pN+, .
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discuss with the patient platinum-based chemotherapy to consider adjuvant nivolumab (category 2B) If neoadjuvant therapy is already received Treatment but ypT2-ypT4 or ypN+, consider adjuvant nivolumab
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● For T3, T4 or N+ tumors, refer to BL-H and consider radiotherapy
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● Footnote added: Most appropriate for patients who value delayed chance of relapse and consider the risk of adverse effects to be acceptable, without improving the chance of receiving a complete remission of the disease
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Reference: [1].
NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Bladder Cancer – Version 5.
2021 Approval number: CN-87918 Validity period: 11/7/2023 Statement: This information is only for medical and scientific communication of medical and health professionals, Not for promotional purposes
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*This article is only used to provide scientific information to medical professionals and does not represent the views of this platform