Frontline Treatments and Cisplatin Eligibility in Metastatic Bladder Cancer
Dr Jain discusses frontline treatment options, cisplatin eligibility criteria, and therapy considerations for metastatic bladder cancer.
Transcript:
Rohit Jain, MD, MPH: So, moving forward discussing…metastatic or advanced bladder cancer, I'll give an overview as to what are the treatment options we have. So, in general, when we see patients, we decide…whether the patient is fit for chemotherapy or not. For that, we say it's platinum-eligible or -ineligible. And that's based upon the overall performance status of the patient. And once we have decided that, yes, we can give chemotherapy, then we decide whether it's a cisplatin-eligible or cisplatinum-ineligible patient. And that is decided based upon some criteria or consensus guidelines, which we call the Galsky criteria. And that basically suggests that if a patient has poor kidney function, peripheral neuropathy, hearing loss, heart failure, or poor performance status, then probably they are not fit for cisplatin. And in the patients who don't have any of these issues, they are the ones who are cisplatin-eligible.
And once we have decided that, yes, cisplatin is the regimen to go [to], then majority of the time, the first-line treatment would consist of either cisplatin with gemcitabine, which is a doublet combination, or we go with dose-dense MVAC, which is a combination of methotrexate, vinblastine, doxorubicin, and cisplatin. Both of the combination [regimens]…actively being used in advanced metastatic urothelial carcinoma have not shown any significant difference in survival or time to progression. But sometimes the cisplatin gemcitabine could have a better toxicity profile. However, with chemotherapy, the responses are rarely durable. And when we say the patient is not chemo-eligible in that situation, we go with the first-line immunotherapy agent, such as atezolizumab or pembrolizumab based upon their respective clinical trials. We try to do the chemotherapy for 4 to 6 cycles, which is followed by maintenance immune therapy treatment.
Transcript is AI-generated and edited for clarity and readability.
