(UroToday.com) At the 2022 American Society of Clinical Oncology Annual Meeting held in Chicago and virtually, the poster session focused on Kidney and Bladder cancers on Saturday afternoon included a presentation from Dr. Shilpa Gupta discussing how we define platinum eligibility for patients with metastatic urothelial carcinoma (UC).
While the treatment landscape has changed significantly for patients with metastatic UC who are ineligible for cisplatin, a platinum-based chemotherapy regime remains the most efficacious treatment approach for patients with advanced UC. Currently, the preferred standard for patients deemed cisplatin ineligible is carboplatin and gemcitabine followed by avelumab. In 2017, both pembrolizumab and atezolizumab were approved as first-line therapy for these patients through the use of first-line pembrolizumab has subsequently been restricted.
In the past, the same authors sought to provide a consensus definition of “platinum-ineligible” patients with mUC. Given changes in the treatment and trial landscape, they reassessed this with the goal of providing an updated consensus definition.
To do so, they surveyed 60 genitourinary medical oncologists in the US (similar cohort to 2019) using an online tool consisting of several clinical parameters used in our initial survey with additional questions related to currently available treatment options. A variety of different age and creatinine thresholds in combination with ECOG performance score were used along with other clinically relevant established criteria. They then compiled the responses to generate a consensus definition.
All survey individuals responded and completed the survey in its entirety. Nearly all (94%) reported using a carboplatin-based regimen followed by Avelumab maintenance therapy while 6% reported using carboplatin-based regimen followed by pembrolizumab for cisplatin-ineligible patients with mUC. There was less consensus regarding the role of PD-L1 testing with 17/60 (28.3%) and 29/60 (48.3%) checking PD-L1 status prior to using pembrolizumab or atezolizumab, respectively.
In terms of defining platinum-ineligibility, the following criteria were proposed:
1. ECOG performance stats of 3 or lower;
2. creatine clearance less than 30 ml/min;
3. Grade 2 or greater peripheral neuropathy;
4. NYHA class III or greater heart failure
5. The combination of ECOG performance status 2 and creatinine clearance less than 30 ml/min.
The authors propose that these criteria may be used to guide treatment recommendations and standardization of eligibility criteria for clinical trials.
Presented by: Shilpa Gupta, MD, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH