Renal pelvis cancer with reduced kidney function (GFR 30–60 ml/min): advanced or metastatic, cisplatin-ineligible
This protocol addresses upper urinary tract urothelial carcinoma (renal pelvis cancer) at an advanced or metastatic stage in patients who are ineligible for cisplatin and ineligible for enfortumab vedotin plus pembrolizumab, but who retain sufficient renal function to receive carboplatin-based therapy.
Carboplatin eligibility in this context is established by either an ECOG performance status of 2 or a glomerular filtration rate (GFR) of 30–60 ml/min. Reduced kidney function — significant enough to preclude cisplatin yet not so severe as to rule out chemotherapy entirely — is the key comorbidity that shapes treatment selection for this population.
For eligible patients in this setting, a carboplatin-containing chemotherapy regimen forms the initial treatment direction, with a structured sequence of further options — including approaches contingent on molecular tumour characteristics and prior treatment history — available for disease that progresses.
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 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.