Counseling Patients With aUC in the Post-EV/Pembrolizumab World

Karine Tawagi, MD, of the University of Illinois College of Medicine, shares how she counsels patients with metastatic bladder cancer, including whether she always recommends EV/pembrolizumab or other considerations there are to make.

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Dr. Tawagi: I think for most patients, it is pretty clear that we are going to offer them EV/pembrolizumab. If they have really bad preexisting neuropathy, that might be a reason to consider a different regimen. If they have very uncontrolled diabetes, maybe we want to get that under control. Generally, if someone has a glucose over 250, we prefer to hold the EV. Otherwise, if they have a history of autoimmune disease that is not well controlled, that would be a reason to not give pembrolizumab.

But for most patients, I would say it is pretty clear I am offering EV/pembrolizumab and asking to be really cognizant of the toxicities that they can have. We can dose-reduce if necessary, if they let us know about the neuropathy, the dermatological toxicity, etc. We will be checking their glucose monitoring for ocular toxicity as well as some others.

View her continued comments.