Editor's Note: Advanced urothelial carcinoma (UC) patients have a poor prognosis with a low 5-year survival rate. Since the 1980s, platinum-based chemotherapy has been the standard first-line therapy for locally advanced or metastatic UC (la/mUC), but the benefits are limited. The real-world tolerance and treatment outcomes of platinum therapy remain unclear. This year's study analyzed data from advanced UC patients in the United States. This article summarizes and organizes the findings for our readers.

This retrospective observational study of patients with locally advanced or metastatic urothelial carcinoma (UC) provides an in-depth analysis of treatment strategies and actual survival outcomes for patients intolerant to platinum-based drugs. The study included patients diagnosed and treated with first-line systemic therapy from January 1, 2016, to December 31, 2021. Among these, 55% tolerated platinum drugs, while 11% were intolerant. Patients intolerant to platinum drugs were characterized by older age and poorer laboratory test indicators. Their median overall survival (OS) was significantly lower than that of platinum-tolerant patients, at 5.1 months versus 13.3 months, respectively. Additionally, the progression-free survival (PFS) of intolerant patients was also shorter, regardless of whether they received PD-1/PD-L1 inhibitors or platinum-based chemotherapy.

The study also found that patients intolerant to platinum drugs had a lower rate of bladder removal surgery and a higher proportion of women in this group. Among intolerant patients receiving first-line treatment, 55% opted for PD-1 or PD-L1 immune checkpoint inhibitors, while 25% still received platinum-based chemotherapy. In contrast, 29% of platinum-tolerant patients received immune checkpoint inhibitor treatment, while 53% received platinum-based chemotherapy. These data highlight the urgent need for new treatment options for advanced UC patients who are intolerant to platinum drugs to improve their survival rates and quality of life. The study results emphasize the necessity for personalized treatment and close monitoring of these patients in clinical practice.