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Thomas Flaig, MD


ASCO 2022: What Is ‘Platinum Ineligibility’ in Patients With Metastatic Urothelial Cancer?

By: Celeste L. Dixon
Posted: Wednesday, June 29, 2022

Updated criteria for defining a patient with metastatic urothelial carcinoma as “platinum-ineligible” have been proposed by Shilpa Gupta, MD, of Taussig Cancer Institute, Cleveland, and colleagues, based primarily on a survey of 60 U.S. genitourinary medical oncologists. The team proposed and published such a consensus definition for standard therapy and clinical trial eligibility using similar methodology in 2019. However, since then, “the treatment landscape has evolved significantly,” they pointed out during their presentation at the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting (Abstract 4577). For platinum-ineligible patients with metastatic urothelial carcinoma, “carboplatin and gemcitabine followed by avelumab maintenance is the current preferred standard.”

The survey results, stated Dr. Gupta and co-investigators, indicate that any patient with metastatic urothelial carcinoma meeting one of the following five parameters should be considered “platinum-ineligible”:

  • Eastern Cooperative Oncology Group (ECOG) performance status of 3 or higher
  • Creatinine clearance of less than 30 mL/min
  • Peripheral neuropathy of grade 2 or higher
  • New York Heart Association heart failure class III or higher
  • Combination of ECOG performance status of 2 and creatinine clearance of less than 30 mL/min.

For patients with metastatic urothelial carcinoma determined to be cisplatin-ineligible, 94% of the survey’s respondents said they use a carboplatin-based regimen followed by avelumab; 6% reported using a carboplatin-based regimen followed by pembrolizumab. Additionally, 28.3% and 48.3% of the oncologists said they checked PD-L1 status prior to using pembrolizumab or avelumab, respectively.

Disclosure: For a full list of study authors’ disclosures, visit

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