The German Society for Urology (DGU) and the German Cancer Society (DKG) have revised the S3 guideline "Early detection, diagnosis, therapy and follow-up of bladder cancer". The update had become necessary due to new approvals of immune checkpoint inhibitors.
According to the German Cancer Society, around 30,000 people in Germany were first diagnosed with bladder cancer in 2016, with men more often than women. The disease occurs with age increase: the mean age of onset is over 70 years. Due to the population aging in Germany, the experts, therefore, assume that the number of new cases will continue to increase in the coming years.
The treatment recommendations for patients with metastatic urothelial carcinoma in first- and second-line therapy have changed fundamentally. In the first line, cisplatin-based combination chemotherapy remains the standard. However, this form of therapy cannot always be used, especially in patients with impaired kidney function, heart failure, or neurological disorders. For the group of patients, who are not suitable for cisplatin-based chemotherapy, immune checkpoint inhibitors can now be used if the tumor cells express PD-L1.
In addition, the guideline also includes new recommendations for immunotherapy, which is a new standard in the second line for metastatic urothelial carcinoma patients with tumor progression after or under chemotherapy containing platinum.
The updated guideline in German can be found here