Cisplatin Eligibility — SCE Medical Oncology MCQ

Correct answer: D — No — cisplatin eligibility typically requires eGFR ≥60 mL/min; at eGFR 55, he is cisplatin-ineligible and should be offered carboplatin-based or alternative neoadjuvant approaches

Cisplatin eligibility criteria (Galsky criteria) include: eGFR ≥60 mL/min, ECOG PS ≤1 (or KPS ≥70), hearing loss ≤grade 1, neuropathy ≤grade 1, and NYHA <class III heart failure. At eGFR 55, this patient does not meet the renal threshold. Options include: carboplatin-based neoadjuvant chemotherapy (inferior but still beneficial), neoadjuvant ICI (clinical trials), or proceeding directly to cystectomy. Split-dose cisplatin over 2 days is sometimes used for borderline renal function but is controversial.

Reference: ESMO 2024 Bladder Cancer; Galsky et al Lancet Oncol 2011