GFR Measured with Computed Tomography for Platinum Treatment Decision-Making in Urothelial Carcinoma: A Retrospective Cohort Study.

Authors

Juliette Poulain, Frédéric Pigneur, Charlotte Fenioux, Charlotte Joly, Carolina Saldana, Marine Aubert, Christophe Tournigand, Philippe Grimbert, Emmanuelle Kempf, Thomas Stehlé

Published in

Kidney360. Nov 13, 2026. Epub Nov 13, 2026.

Abstract

Accurate assessment of glomerular filtration rate (GFR) is essential for cisplatin eligibility and carboplatin dosing. We recently demonstrated that GFR measured using iodinated contrast agent clearance derived from 4-phase CT urography (CT-mGFR) showed good agreement with iohexol clearance in both healthy individuals and patients with chronic kidney disease. We aimed to evaluate the impact of CT-mGFR on platinum selection and whether CT-mGFR-based carboplatin dosing might reduce toxicity in urothelial carcinoma.
This single-center retrospective cohort study included patients with urothelial carcinoma treated with platinum-based chemotherapy who had 4-phase CT urography within 6 months before cancer treatment and stable estimated GFR (eGFR). Primary endpoints were, first, the proportion of patients in whom CT-mGFR would have changed the choice between cisplatin and carboplatin compared with 2009 CKD-EPIcr based decision-making (equation used in routine clinical practice in France) using a 60 ml/min/1.73m2 threshold, and second, the association between grade 3-4 carboplatin-related hematologic toxicity and the relative dose difference between CT-mGFR-predicted and administered doses. Relative dose differences within ±15% were considered concordant. Severe hematologic toxicity was defined as Common Terminology Criteria for Adverse Events grade 3-4. Associations were assessed using Fisher's exact test and logistic regression.
Forty-seven patients were included (79% male), with a median age of 69 years (IQR, 62-75). CT-mGFR and 2009 CKD-EPIcr-based eGFR led to discordant platinum treatment decisions in 10 patients (21%). The sensitivity and specificity of 2009 CKD-EPIcr for identifying CT-mGFR <60 mL/min/1.73m2 were 68.4% and 85.7%, respectively. CT-mGFR-based carboplatin dosing identified potential overdosing in 4 patients, 3 of whom developed severe hematologic toxicity, compared with 1 of 9 patients with concordant dosing and none of 6 with underdosing (p=0.02).
CT-mGFR may help optimize platinum treatment decision-making and carboplatin dosing in urothelial carcinoma. These findings should be confirmed in larger prospective multicenter studies.

PMID:
43023805
Bibliographic data and abstract were imported from PubMed on 13 Nov 2026.

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