This letter critically examines the implications of the EV-302/KEYNOTE-869 trial (enfortumab vedotin + pembrolizumab in cisplatin-eligible muscle-invasive/metastatic bladder cancer) and questions whether the traditional cisplatin-eligibility framework—established by Galsky et al. in 2011—remains relevant in the current treatment landscape.
The letter argues that strong efficacy data for enfortumab vedotin + pembrolizumab in cisplatin-eligible patients may render the cisplatin-eligibility distinction clinically obsolete, challenging the longstanding practice of reserving certain regimens for cisplatin-ineligible patients only.
This is an editorial letter, not an original study—no new primary data or patient-level outcomes are reported. Conclusions are interpretive and based on referenced trial results rather than independent analysis.
Clinicians should reconsider defaulting to cisplatin-based chemotherapy as the standard first-line regimen for muscle-invasive bladder cancer; the enfortumab vedotin + pembrolizumab combination may be appropriate regardless of cisplatin eligibility status, pending guideline updates.
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