Reassessing Cisplatin Eligibility in Urothelial Carcinoma: A Retrospective Study on Dose Reduction Strategies

Background This study aims to assess the impact of reduced cisplatin doses on treatment efficacy and toxicity in patients with urothelial carcinoma (UC) and renal impairment. Current guidelines suggest excluding patients with renal impairment from cisplatin treatment. However, reevaluating the efficacy of dose-adjusted cisplatin based on renal function is crucial. Methods A retrospective study was conducted on 68 patients diagnosed with locally advanced or metastatic UC (T2-4N0M0, TanyN1-3M0 or TanyNanyM1) between 2017 and 2024. These patients were divided into two groups: 40 received a full dose (100%) of cisplatin (CDDP:70-135mg) and 28 received a 75% dose (CDDP:60-120mg). Clinical outcomes and adverse effects were analyzed and compared between these two groups, with a particular focus on patients with renal impairment (estimated glomerular filtration rate (eGFR) 50-60). Results Complete response (CR) rates were 15.0% for the full-dose group and 14.3% for the 75% dose group, while partial response (PR) rates were 35.0% and 42.9%, respectively. The overall response rates (CR + PR) were 50.0% for the full dose and 57.2% for the 75% dose. For patients with renal impairment, the 75% dose group demonstrated similar efficacy and adverse effect profiles compared to the full-dose group. Conclusions The findings suggest that reduced doses of cisplatin, based on renal function, do not compromise treatment efficacy in UC patients. Thus, expanding cisplatin eligibility to include UC patients with renal impairment (eGFR 30-60 mL/min) is warranted, indicating that dose-adjusted cisplatin treatment is a viable option.