Impact of European Association of Urology Combination and Platinum Eligibility on Real‐World Treatment Sequences and Survival in Japanese Patients With Metastatic Urothelial Carcinoma

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.