Patients with metastatic or unresectable urothelial carcinoma who cannot receive cisplatin-based chemotherapy represent a distinct clinical population with specific first-line treatment considerations. This protocol addresses that subset, particularly where enfortumab vedotin is also contraindicated or unavailable.
Clinical scenario: A glomerular filtration rate of 30–60 mL/min or an ECOG performance status of 2 renders patients ineligible for cisplatin-based chemotherapy. Approximately half of all patients with bladder cancer fall into this cisplatin-ineligible category. When enfortumab vedotin cannot be used or is not accessible, this pathway applies.
A carboplatin-based combination chemotherapy regimen is recommended as first-line treatment for this population, with a maintenance strategy for patients who achieve at least stable disease on chemotherapy — full agent selection and sequencing are in the protocol.
Treatment goal: Objective response or stable disease.
If contraindications for EV or EV not available: Offer platinum-containing combination chemotherapy (cisplatin or carboplatin plus gemcitabine) followed by maintenance treatment with CPI avelumab in patients with at least stable disease on chemotherapy.
The combination of carboplatin and gemcitabine should be considered a standard of care in this patient group.
Approximately 50% of patients with BC are not eligible for cisplatin-based chemotherapy.
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