Background: For many decades, gemcitabine + cisplatin has been a preferred and accepted treatment option for patients with urothelial cancer (UC). In patients ineligible for standard-dose cisplatin, split-dose cisplatin is a promising alternative. This study aimed to provide insights into the use of split-dose cisplatin and factors influencing treatment choice. Methods: Between January and March 2024, an international cross-sectional survey was carried out, which involved oncologists and urologists treating patients with locally advanced/metastatic UC (la/mUC) in Australia, Brazil, Canada, France, Germany, India, Italy, Spain, the UK, and the USA. Demographics, practice patterns, and clinical parameters influencing treatment choice were collected. Results: Of the 791 respondents, most were male (73%), the mean age was 43 years, and the mean time spent in clinical practice was 13 years. In total, 85% reported using split-dose cisplatin in UC, ranging from 97% in Canada to 67% in Brazil. The preferred schedule in la/mUC was gemcitabine + cisplatin 35 mg/m2on days 1 and 8 of 21-day cycles (57%). Most respondents (64%) were comfortable prescribing split-dose cisplatin to otherwise fit patients with a creatinine clearance ≥40 mL/min. Standard- and split-dose cisplatin were preferred regimens for otherwise fit patients with creatinine clearance of 45–60 mL/min. Conclusions: This large international survey demonstrates the extensive use of split-dose cisplatin in patients with la/mUC. Responses indicate that split-dose cisplatin is administered to patients in clinical practice with a wider range of creatinine clearance, performance status, and comorbidities than suggested for standard-dose cisplatin. Results highlight the need to evaluate split-dose cisplatin prospectively and establish consensus guidelines for its use, especially in patients unfit for standard-dose cisplatin.
背景：数十年来，吉西他滨联合顺铂方案一直是尿路上皮癌患者优选且公认的治疗方案。对于无法耐受标准剂量顺铂的患者，分次剂量顺铂方案是一种具有前景的替代选择。本研究旨在深入探讨分次剂量顺铂的应用现状及影响治疗方案选择的因素。 方法：2024年1月至3月期间，在澳大利亚、巴西、加拿大、法国、德国、印度、意大利、西班牙、英国和美国开展了一项国际横断面调查，对象为治疗局部晚期/转移性尿路上皮癌的肿瘤科和泌尿外科医师。调查收集了人口统计学特征、临床实践模式及影响治疗选择的临床参数。 结果：在791名受访者中，男性占73%，平均年龄43岁，平均临床实践年限13年。总体85%的受访者在尿路上皮癌治疗中使用分次剂量顺铂，各国使用率从加拿大的97%到巴西的67%不等。局部晚期/转移性尿路上皮癌最常用的方案为21天周期中第1、8天给予吉西他滨联合顺铂35 mg/m²（57%）。多数受访者（64%）对肌酐清除率≥40 mL/min且身体状况良好的患者使用分次剂量顺铂感到放心。对于肌酐清除率45-60 mL/min且身体状况良好的患者，标准剂量与分次剂量顺铂均为优选方案。 结论：这项大规模国际调查表明分次剂量顺铂在局部晚期/转移性尿路上皮癌患者中得到广泛应用。调查结果显示，临床实践中接受分次剂量顺铂治疗患者的肌酐清除率、体能状态及合并症范围，较标准剂量顺铂的适用标准更为宽泛。研究结果强调有必要对分次剂量顺铂开展前瞻性评估，并建立其临床应用共识指南，特别是针对无法耐受标准剂量顺铂的患者群体。
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