Treatment of Advanced or Metastatic Renal Pelvis Cancer in Cisplatin-Eligible Patients with Glomerular Filtration Rate > 50 ml/min (eGFR-Adequate)
This protocol addresses upper urinary tract urothelial carcinoma (UUTUC) at an advanced or metastatic stage in patients who meet cisplatin eligibility criteria — including adequate renal function — but are not candidates for enfortumab vedotin combined with pembrolizumab.
Patient Scenario
- Upper urinary tract urothelial carcinoma — advanced or metastatic disease
- Ineligible for enfortumab vedotin + pembrolizumab
- Cisplatin-eligible — ECOG performance status 0–1
- Glomerular filtration rate (eGFR) > 50 ml/min
- Audiometric hearing loss < grade 2
- Peripheral neuropathy < grade 2
- NYHA cardiac class < III
Treatment Approach (Partial Overview)
First-line management for these patients centres on cisplatin-based chemotherapy combinations. For patients whose disease subsequently progresses, further options are available — including, in select patients, a targeted agent for those who harbour specific molecular alterations.
The complete treatment sequence, eligibility criteria for each option, and subsequent-line algorithm are available in the full 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 erdafitinib as an alternative subsequent-line therapy to patients: Previously treated with platinum-containing chemotherapy; Who had disease progression during or after treatment with a PD-1 or PD-L1 inhibitor; Who harbour FGFR DNA genomic alterations (FGFR2/3 mutations or FGFR3 fusions).
- 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.
- Only offer vinflunine as a second-line treatment to patients with metastatic disease if immunotherapy or combination chemotherapy is not feasible.
- Alternatively, offer vinflunine as a third- or subsequent-line treatment.
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