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Bladder Cancer — SCE Medical Oncology MCQ

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HardUrological CancersBladder CancerSCE Medical Oncology

A fit patient has untreated metastatic urothelial carcinoma, ECOG 1 and eGFR 35 mL/min. He is unsuitable for cisplatin but suitable for carboplatin. Which NICE-recommended first-line option now has priority when otherwise clinically suitable?

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Correct answer: D — Enfortumab vedotin plus pembrolizumab for initial systemic therapy

NICE TA1097 recommends enfortumab vedotin plus pembrolizumab for untreated unresectable or metastatic urothelial cancer when platinum chemotherapy is suitable. eGFR 35 mL/min makes cisplatin unsuitable but does not preclude carboplatin, so the patient remains platinum-suitable. The previous key to atezolizumab was outdated.

Reference: NICE TA1097 enfortumab vedotin with pembrolizumab: recommendation (Published November 2025): https://www.nice.org.uk/guidance/ta1097/chapter/1-Recommendation; NICE NG2 bladder cancer: recommendations (Current NICE guidance, accessed August 2026): https://www.nice.org.uk/guidance/ng2/chapter/Recommendations