Genitourinary SACT Regimens

The information contained in these regimens is a statement of consensus of NCCP and ISMO or IHS professionals regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. The treatment regimen to be used should take into account factors such as histology, molecular pathology, age, performance status, co-morbidities and the patient’s preference. Each treatment regimen has advantages and disadvantages, and there may be more than one good option. In addition, treatment choices can change over time as more evidence becomes available. Use of these documents is the responsibility of the prescribing clinician and is subject to the HSE.ie terms of use.

Please email any comments or feedback on these regimens to oncologydrugs@cancercontrol.ie.

See Bladder Cancer Regimens
See Germ Cell Regimens
See Prostate Regimens
See Renal Regimens

For information on open clinical trials please refer to the Cancer Trials Ireland website and also to basket trials.

Bladder Cancer Chemotherapy Regimens

PD-L1 IHC request Form Urothelial Cancer
Regimen Name	Indication
Atezolizumab Monotherapy - 21 day Regimen	00544b Treatment of adult patients with locally advanced or metastatic urothelial carcinoma (UC) after prior platinum-containing chemotherapy. 00544c Treatment of adult patients with locally advanced or metastatic urothelial carcinoma (UC) who are considered cisplatin ineligible and whose tumours have a PD-L1 expression ≥5%
Atezolizumab 1680mg Monotherapy - 28 Day Regimen	00593b Treatment of adult patients with locally advanced or metastatic urothelial carcinoma (UC) after prior platinum-containing chemotherapy. 00593c Treatment of adult patients with locally advanced or metastatic urothelial carcinoma (UC) who are considered cisplatin ineligible and whose tumours have a PD-L1 expression ≥5%.
Avelumab Monotherapy Regimen	00535 First-line maintenance treatment of adult patients with locally advancedor metastatic urothelial carcinoma (UC) who are progression-free following platinum based chemotherapy
CISplatin 40mg/m2 Weekly with Radiotherapy (RT) Regimen	00385b Chemoradiation treatment for locally advanced bladder cancer.
Cisplatin, Methotrexate and Vinblastine (CMV) Therapy Regimen	00337a Neoadjuvant treatment of muscle invasive transitional cell carcinoma (TCC) of the urothelium.
Erdafitinib Monotherapy Regimen	00885a As monotherapy for the treatment of adult patients with unresectable or metastatic urothelial carcinoma (UC), harbouring susceptible FGFR3 genetic alterations who have previously received at least one line of therapy containing a PD-1 or PD-L1 inhibitor in the unresectable or metastatic treatment setting.
Enfortumab vedotin Monotherapy Regimen	00846a For the treatment of adult patients with locally advanced or metastatic urothelial carcinoma (UC) who have previously received a platinum-containing chemotherapy and a programmed death receptor 1 (PD-1) or programmed death ligand 1 inhibitor (PD-L1).
5-Fluorouracil (5 day) and mitoMYcin Chemoradiation Therapy Regimen	00450a Treatment of muscle invasive bladder cancer in patients.
Gemcitabine (1000mg/m2) and CISplatin (35mg/m2) Therapy- 21 day Regimen	00622a Treatment of patients with locally advanced or metastatic transitional cell carcinoma (TCC) of the urothelium in patients with impaired renal function.
Gemcitabine (1000mg/m2) and CISplatin (70mg/m2) Therapy- 21 day Regimen	00628a Adjuvant treatment of upper tract urothelial carcinoma.
Gemcitabine (1000mg/m²) and CARBOplatin (AUC5) Therapy-21 day Regimen	00310a Treatment of patients with locally advanced or metastatic transitional cell carcinoma (TCC) of the urothelium where CISplatin is contraindicated.*
Gemcitabine (1000mg/m²) and CISplatin (70mg/m²) Therapy-28 day Regimen	00282a Treatment of patients with locally advanced or metastatic transitional cell carcinoma (TCC) of the urothelium.
Methotrexate, VinBLAStine, DOXOrubicin, CISplatin (MVAC) Therapy-14 days Regimen	00333a Locally advanced or metastatic transitional cell carcinoma (TCC) of the urothelium.
Methotrexate, vinBLAStine, DOXOrubicin, CISplatin (MVAC) Therapy-28 days Regimen	00338a Neoadjuvant treatment of muscle invasive transitional cell carcinoma (TCC) of the urothelium. 00338b Adjuvant treatment of muscle invasive TCC of the urothelium. 00338c Locally advanced or metastatic TCC of the urothelium.
PACLitaxel Monotherapy 80mg/m2 Day 1, 8, 15 and 22 - 28 Day Regimen	00226e Second line chemotherapy for metastatic bladder cancerⁱⁱ.
PACLitaxel 80mg/m2 Day 1, 8 and 15 Monotherapy-28 Day Regimen	00621e Second line chemotherapy for metastatic bladder cancer.
Pembrolizumab 200mg Monotherapy Regimen	00455e As monotherapy for the treatment of locally advanced or metastatic urothelial carcinoma in adults who have received prior platinum-containing chemotherapy. 00455f As monotherapy is indicated for the treatment of locally advanced or metastatic urothelial carcinoma in adults who are not eligible for cisplatin-containing chemotherapy whose tumours express PD-L1 with a combined positive score (CPS) ≥10. 00455m For the adjuvant treatment of adult patients with renal cell carcinoma (RCC) at increased risk of recurrence following nephrectomy, or following nephrectomy and resection of metastatic lesions.
Pembrolizumab 400mg Monotherapy Regimen	00558e As monotherapy for the treatment of locally advanced or metastatic urothelial carcinoma in adults who have received prior platinum-containing chemotherapy. 00558f As monotherapy is indicated for the treatment of locally advanced or metastatic urothelial carcinoma in adults who are not eligible for cisplatin-containing chemotherapy whose tumours express PD-L1 with a combined positive score (CPS) ≥10. 00558m For the adjuvant treatment of adult patients with renal cell carcinoma (RCC) at increased risk of recurrence following nephrectomy, or following nephrectomy and resection of metastatic lesions.

Germ Cell Chemotherapy Regimens

Regimen Name	Indication
Bleomycin, Etoposide and CISplatin (BEP) Therapy Regimen	00300a Adjuvant treatment of high risk (vascular invasion carcinoma) stage 1 non-seminoma germ cell tumour. 00300b Metastatic germ cell tumours of the testis. 00300c Advanced stage or metastatic germ cell tumours (dysgerminoma) of the ovaries. 00300d Extra-gonadal germ cell tumours.
CARBOplatin (AUC7) and Etoposide - Autologous Conditioning Germ Cell Tumour Regimen Regimen	00453a Treatment of metastatic relapsed/refractory germ cell tumours.
Etoposide and CISplatin 20mg/m² (EP) 5 Day Therapy Regimen	00301a Treatment of good prognosis (IGCCCG criteria) metastatic germ cell tumours (both non-seminoma and seminoma).
PACLitaxel, Ifosfamide, and CISplatin (TIP) Therapy Regimen	00602a Treatment of relapsed / refractory metastatic testicular germ cell cancer.

Regimen Name

Indication

Bleomycin, Etoposide and CISplatin (BEP) Therapy