70 year old male with borderline renal function, CrCl 50, locally advanced urothelial ca of bladder, T4N0, s/p 1 cycle of neoadjuvant Gem+ Cisplatin (split dose), developed worsening AKI after 1 dose of cisplatin, no recovery in renal function despite aggressive IV hydration and witholding cisplatin. Would you switch to carbo to complete remainder of the neoadjuvant course? Alternatively, would you proceed straight to cystectomy and consider adjuvant nivolumab instead?
At this time, if he can't get any more cisplatin (even if split dose cisplatin - 35 mg/m2 day 1 and day 8 and aggressive hydration as you mentioned) then i would move him to surgery and would not recommend carboplatin. I would then discuss adjuvant nivolumab with him if pT2+. I would also consider doing ctDNA (signatera) to help decide, if you have it available.
