For patients with muscle-invasive bladder cancer and borderline renal function, would you consider use of a split-dose cisplatin/gemcitabine regimen for neoadjuvant treatment?

Yes, in patients with borderline creatinine clearance, e.g. 50-59cc/min, we tend to split cisplatin dose, e.g. 35 mg/m2 on days 1 and 8, if gemcitabine/cisplatin is used, or on days 1 and 2, if dd-MVAC is used. Also, we consider 24-hour urine testing to assess more accurately creatinine clearance in...

To add to @Dr. First Last's answer, we recently did a small single-institution retrospective comparison of split-dose vs standard cisplatin regiments in the neoadjuvant setting for MIBC patients with GFR<60 ml/min. The numbers were small as there were only 11 patients in thiscohort who received spli...