CTCAE-Guided Management of Cytotoxic Chemotherapy Toxicity in Uro-Oncology: A Contemporary Narrative Review.

Abstract

Cytotoxic chemotherapy remains integral to contemporary uro-oncology despite the rapid expansion of targeted therapy, antibody-drug conjugates, and immunotherapy. Its role is especially critical where therapeutic success depends on maintaining adequate dose intensity, most notably in metastatic testicular germ cell tumours and in cisplatin-based perioperative treatment for muscle-invasive bladder cancer. In metastatic prostate cancer and selected penile squamous cell carcinoma, taxane- and platinum-based regimens also retain clinical value but are constrained by hematologic, neurologic, renal, pulmonary, and gastrointestinal toxicities. This narrative review summarises current evidence and guideline recommendations for Common Terminology Criteria for Adverse Events (CTCAE)-guided management of chemotherapy toxicity across major uro-oncologic disease settings. A practical emphasis is placed on pretreatment risk stratification, cycle-by-cycle surveillance, supportive care, and intent-adapted treatment modification. Across tumour types, early recognition of grade 2 toxicity, urgent management of febrile neutropenia and organ toxicity, and thoughtful preservation of dose intensity when cure is realistic are the central management principles. In older, frail, immunosuppressed, heavily pretreated, or organ-limited patients, CTCAE grades must be interpreted against baseline reserve and cumulative toxicity.