Advanced Renal Pelvis Cancer When Cisplatin Is Not an Option — Reduced Kidney Function (eGFR 30–60 mL/min) or ECOG PS 2
Clinical Scenario
This protocol covers advanced or metastatic upper urinary tract urothelial carcinoma in patients who cannot receive cisplatin but are eligible for carboplatin — specifically those with a glomerular filtration rate (eGFR) of 30–60 mL/min or an ECOG performance status of 2, and who are also ineligible for enfortumab vedotin plus pembrolizumab combination therapy.
Key eligibility factor: Carboplatin eligibility in this setting is defined by reduced kidney function (eGFR 30–60 mL/min) or ECOG performance status 2 — criteria that exclude standard cisplatin-based regimens and the preferred combination immunotherapy option.
Treatment Approach
Depending on treatment history, management in this population may involve immunotherapy or an antibody-drug conjugate. Agent selection is guided by specific prior treatment criteria.
The complete sequencing, selection criteria, and clinical decision points are in the full structured protocol.
References
DOI: 10.1016/j.eururo.2025.02.023
- Offer gemcitabine/carboplatin chemotherapy to cisplatin-ineligible patients.
- Offer maintenance avelumab to patients who did not have disease progression after 4–6 cycles of platinum-based combination chemotherapy.
- 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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