OBJECTIVES: To evaluate the prevalence of European Association of Urology-defined combination and platinum eligibility at first-line treatment initiation, and to assess their impact on conventional treatment sequence and overall survival in a real-world Japanese cohort. METHODS: We retrospectively analyzed 148 patients with metastatic urothelial carcinoma who initiated systemic chemotherapy between 2018 and 2024 at a single institution in Japan. Cisplatin eligibility was assessed according to the Galsky criteria. Combination therapy eligibility and platinum eligibility were defined according to the European Association of Urology guideline. RESULTS: Among the 148 patients, 128 (86.5%) were combination-eligible and 20 (13.5%) ineligible. Among combination-eligible patients, 70 (54.7%) were cisplatin-eligible, 47 (36.7%) cisplatin-ineligible but platinum-eligible, and 11 (8.6%) platinum-ineligible. Median overall survival was significantly longer in combination-eligible patients than in combination-ineligible patients (25 vs. 16 months, p = 0.019, HR 2.46, 95% CI 1.16-5.23). Within the combination-eligible group, cisplatin-eligible patients tended to show superior median overall survival (not reached) compared with cisplatin-ineligible/platinum-eligible (25 months) and platinum-ineligible (15 months, p = 0.11 and p = 0.082, respectively). Only 25.0% (32/128) of combination-eligible patients received the chemotherapy-immune checkpoint inhibitor-enfortumab vedotin sequence, while 20.0% (4/20) of combination-ineligible patients also completed this sequence. CONCLUSIONS: European Association of Urology-defined combination and platinum eligibility were associated with survival outcomes and treatment sequence capability in a real-world setting. These findings highlight the prognostic value but practical limitations of eligibility criteria, emphasizing the need to develop more practical classification frameworks that ensure broader access to effective therapy.
Kawahara et al. (2026) studied this question.