Criteria Used to Determine Platinum Eligibility in Patients with Metastatic Urothelial Carcinoma: Results of a Physician Survey in Five European Countries.

Background and objective: Although, for decades, first-line treatment for metastatic urothelial carcinoma (mUC) has been based on eligibility for platinum-based chemotherapy (cisplatin or carboplatin), the platinum-ineligibility criteria used by European physicians in real-world practice are unclear. This study assessed the factors and clinical thresholds used by European physicians to determine platinum ineligibility and alignment with the published US thresholds. Methods: Physicians in France, Germany, Italy, Spain, and the UK completed a quantitative online survey from August to September 2022. Physicians reported percentages of patients perceived as platinum eligible and factors considered when determining platinum ineligibility. A previous US-based survey was adapted to identify European consensus thresholds. Differences between European and US consensus thresholds were assessed using Key findings and limitations: In total, 503 physicians (69% oncologists and 31% urologists) completed the survey. Respondents reported that 77% of treated patients with mUC were platinum eligible. European (vs US) consensus thresholds for platinum ineligibility were creatinine clearance of <25 ml/min (vs <30 ml/min) or peripheral neuropathy grade ≥3 (vs grade ≥2). Consensus thresholds were the same for Eastern Cooperative Oncology Group performance status ≥3 and New York Heart Association class III. The European consensus age threshold was 80 yr (vs no threshold in the US study). Limitations include a potential bias due to voluntary participation. Conclusions and clinical implications: European physicians considered most patients with mUC to be platinum eligible. Ineligibility criteria were broadly consistent with US results, except for age. Standardization and wider use of these criteria could support decision-making, reduce variations in care, and improve patient outcomes. Patient summary: A survey of doctors from five European countries (France, Germany, Italy, Spain, and the UK) found that most people with metastatic urothelial cancer (77%) should be able to receive platinum-based chemotherapy. The characteristics considered by European doctors to decide whether a person can receive platinum-based chemotherapy were similar to those reported previously by US doctors, except for age. Specifically, most European doctors (67%) reported that they may be reluctant to prescribe platinum-based chemotherapy to a >80-yr-old person with metastatic urothelial cancer, whereas US doctors reported that they did not consider age in their decision.