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Algorithm for Determining Cisplatin-Eligibility in MIBC
Patient is otherwise fit for cisplatin (ideally meeting the following Galsky criteria)
• WHO or ECOG performance status <2, or Karnofsky performance status >60-70% No
• CTCAE v5 grade <2 peripheral neuropathy
• CTCAE v5 grade <2 audiometric hearing loss
eGFR (CKD-EPI preferred) and/or • NYHA class <III heart failure
24-h urine collection if feasible
Yes
eGFR or BSA-adjusted eGFR or BSA-adjusted eGFR or BSA-adjusted eGFR or BSA-adjusted
eGFR > 60 mI/min eGFR > 50 mI/min eGFR 40-50 mI/min eGFR <40 mI/min
Potentially Cisplatin ineligible
Cisplatin eligible Cisplatin eligible
cisplatin eligible Consider decompression
(discuss on a case by case basis) if acute obstructive
nephropathy is present
Consider the following nephrotoxicity mitigation strategies:
• Decompression if acute obstructive uropathy is present
• Nephrology consultation before cisplatin administration
• Aggressive hydration before, during and after treatment
• Minimize concomitant nephrotoxic medications
• Dose reduction of conventional cisplatin regimes (25-50%)
• Cisplatin dose fractionation using the split-dose gemcitabine
2
and cisplatin regimen (cisplatin 35 mg/m on day 1 and day 8)
Jiang DM, et al. Nat Rev Urol. 2021;18(2):104-114.
