Median survival around 14 months, with 5 year survival rates 5 – 20 %.
40 – 70 % patients have an initial response to platinum based chemotherapy.
EAU guidelines:
First line is gem-cis (or ddMVAC)
Carboplatin can be used for renal dysfunction but cisplatin is preferred if able
If good response or no progression – maintenance avelumab immunotherapy (JAVELIN trial – OS 21 months vs 14 months after platinum chemo).
If progression despite platinum chemotherapy – pembrolizumab immunotherapy.
Prognostic factors:
- Performance status
- Visceral and liver metastases (worse prognosis)
- Anaemia
Patients with tumours that have high expression of PD-L1, high mutation burden and luminal subtype probably respond better to immunotherapy.
Erdafitinib is approved for patients with FGFR mutations in USA.
Involve palliative care, rad onc for bony metastases.