Treatment of Advanced or Metastatic Renal Pelvis Cancer with Adequate GFR — Cisplatin-Eligible Patients Ineligible for Enfortumab Vedotin plus Pembrolizumab
Clinical Scenario
This protocol applies to patients with upper urinary tract urothelial carcinoma that is advanced or metastatic, who are not eligible for enfortumab vedotin combined with pembrolizumab but do meet criteria for cisplatin-based treatment.
Cisplatin Eligibility Criteria (All Must Be Met)
Patients are assessed against the following parameters to confirm cisplatin suitability:
ECOG PS 0–1
GFR > 50 ml/min
Hearing loss < grade 2
Peripheral neuropathy < grade 2
NYHA cardiac class < III
Treatment Approach (Partial Overview)
The protocol addresses both first-line cisplatin-based treatment and, depending on prior therapy received, subsequent management — which may involve immunotherapy or an antibody-drug conjugate. The full selection criteria, sequence, and regimen details are available in the structured protocol.
References
DOI: 10.1016/j.eururo.2025.02.023
- First-line treatment for platinum-eligible patients unsuitable/ineligible for EV + P.
- Offer cisplatin-based chemotherapy with gemcitabine/cisplatin or HD-MVAC to cisplatin-eligible patients.
- Offer cisplatin-based chemotherapy with gemcitabine-cisplatin + nivolumab to cisplatin-eligible patients.
- Offer pembrolizumab to patients with disease progression during or after platinum-based combination chemotherapy for metastatic disease who did not receive maintenance avelumab.
- Offer EV to patients previously treated with platinum-containing chemotherapy and who had disease progression during or after treatment with a PD-1 or PD-L1 inhibitor.
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