Dr. Gupta on Unmet Needs in Frontline Treatment of Metastatic Urothelial Cancer.

Shilpa Gupta, MD, oncologist, Hematology and Medical Oncology, Cleveland Clinic, discusses the unmet needs of patients with cisplatin-ineligible metastatic urothelial carcinoma (mUC).

A minority of patients with mUC receive second-line therapy, indicating there is still a need to improve patient survival in the first-line setting. Treatment selection in the frontline is determined by the patient's eligibility for the platinum-based therapy.

Less than 10% of patients with mUC are truly platinum-ineligible. The consensus definition for determining complete platinum-ineligibility involves an ECOG performance status of 3 or higher, peripheral neuropathy grade 2 or higher, significant heart failure, and a creatine clearance (CrCL) of less than 30 ml/minute.

Patients who are determined to be platinum-eligible will typically receive cisplatin-based chemotherapy. If they do not progress on chemotherapy, this regimen will be followed by maintenance avelumab (Bavencio). Patients who are cisplatin-ineligible could receive atezolizumab (Tecentriq) or pembrolizumab (Keytruda). However, they are usually directed towards the current preferred standard of gemcitabine in combination with carboplatin, followed by maintenance avelumab.