Treatment of Advanced Renal Pelvis Cancer with Reduced Kidney Function (eGFR 30–60 mL/min)
Clinical scenario
This protocol applies to upper urinary tract urothelial carcinoma that is advanced or metastatic. The specific population is patients who are cisplatin-ineligible yet carboplatin-eligible — defined by an eGFR of 30–60 mL/min or an ECOG performance status of 2 — and who are not candidates for enfortumab vedotin plus pembrolizumab.
Treatment approach (partial)
First-line management centres on a carboplatin-based chemotherapy combination. For patients whose disease does not progress on initial chemotherapy, a maintenance immunotherapy strategy is subsequently incorporated. The complete regimen sequence, eligibility criteria, timing, and monitoring details are available in the full structured protocol.
References
DOI: 10.1016/j.eururo.2025.02.023
- Offer gemcitabine/carboplatin chemotherapy to cisplatin-ineligible patients.
- Carboplatin with gemcitabine is the preferred regimen, irrespective of PD-L1 status.
- Offer maintenance avelumab to patients who did not have disease progression after 4–6 cycles of platinum-based combination chemotherapy.
- Avelumab maintenance therapy after 4–6 cycles of gemcitabine plus cisplatin or carboplatin (started within 10 wk of completion of first-line PBC) significantly prolonged OS in comparison to best supportive care alone for patients with advanced or metastatic UC who did not experience disease progression during, or responded to, first-line chemotherapy.
View source ↗