Metastatic bladder cancer
Prognostic factors associated with worse survival includes :Patient factors: KPS < 80, ECOG 2 or higher, Mets to viscera, Anemia, shorter remission from prior therapy
Patient comorbidities: mycarg.org chemotoxicity calculator
Molecular alteration- FGFR3 alteration, HER 2 amplified, CPS score
Cisplatin eligibility
- World Health Organization (WHO)/Eastern Cooperative Oncology Group (ECOG) performance status less than 2 (table 3) or a Karnofsky Performance Status greater than 70 percent
- Creatinine clearance greater than or equal to 60 mL/minute
- No significant hearing loss (measured at audiometry of 25 dB at two contiguous frequencies)
- Grade <2 peripheral neuropathy (ie, sensory alteration or paresthesia, including tingling, but not interfering with activities of daily living)
- No clinical evidence of New York Heart Association class III or greater heart failure
Carboplatin eligibility — Good performance status but ineligible for cisplatin-based combination chemotherapy due to kidney dysfunction, neuropathy, severe hearing loss, neuropathy, and/or heart failure
Immunotherapy eligibility — autoimmune conditions, infectious disorders, and previous exposure to immunomodulating agents
Enfortumab vedotin eligibility — Patients who are candidates to receive enfortumab vedotin plus pembrolizumab should receive a complete skin examination, ophthalmological assessment, measurement of glucose levels and kidney function, and a neurological evaluation. Patients with uncontrolled diabetes mellitus (HbA1c ≥8 percent or HbA1c 7 percent to <8 percent with associated symptoms of diabetes), a severe dermatologic condition, grade ≥2 neuropathy, and/or creatinine clearance ≤30 mL/minute are ineligible for this regimen.
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