Fast Five Quiz: Management of Metastatic Bladder Cancer

Kyle A. Richards, MD


January 30, 2023

Many patients who are diagnosed with bladder cancer are older, with multiple comorbidities. This makes cisplatin-containing therapy challenging because of the increased risk for toxicities: nephrotoxicity, worsening nausea and vomiting, significant neurotoxicity, myelosuppression, ototoxicity, and neuropathy.

Approximately 50% of patients are not fit for cisplatin therapy (making the potential for an alternative treatment with enfortumab vedotin and pembrolizumab even more impactful); low renal function and poor Eastern Cooperative Oncology Group (ECOG) performance status are the most common causes, according to Srikala S. Sridhar.

According to the Galsky criteria, unfit patients meet at least one of these criteria:

  • ECOG performance status ≥ 2

  • Creatine clearance ≤ 60 mL/min

  • Hearing loss grade ≥ 2

  • Neuropathy grade ≥ 2

  • New York Heart Association class 3 heart failure

Learn more about metastatic bladder cancer management.


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