Tripathi Nishita, Gebrael Georges, Chigarira Beverly, Sahu Kamal Kant, Balasubramanian Ishwarya, Caparas Constance, Mathew Thomas Vinay, Cohan Jessica N, Pelletier Kaitlyn, Maughan Benjamin L, Agarwal Neeraj, Swami Umang, Gupta Sumati
Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA.
Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA.
Cancers (Basel). 2024 Jun 5;16(11):2143. doi: 10.3390/cancers16112143.
Metastatic urinary tract cancer (mUTC) is challenging to treat in older adults due to comorbidities. We compared the clinical courses of younger and older (≥70 years) adults with mUTC receiving first-line (1L) systemic therapy in a tertiary cancer center. Baseline clinical characteristics, treatments received, tolerability, and survival outcomes were analyzed. Among 212 patients (103 older vs. 109 younger), the older patients had lower hemoglobin at baseline (84% vs. 71%, = 0.03), the majority were cisplatin-ineligible (74% vs. 45%, < 0.001), received more immunotherapy-based treatments in the 1L (52% vs. 36%, = 0.01), received fewer subsequent lines of treatment (median 0 vs. 1, = 0.003), and had lower clinical trial participation (30% vs. 18%, = 0.05) compared to the younger patients. When treated with 1L chemotherapy, older patients required more dose adjustments (53.4% vs. 23%, = 0.001) and received fewer cycles of chemotherapy (median 4 vs. 5, = 0.01). Older patients had similar OS (11.2 months vs. 14 months, = 0.06) and similar rates of treatment-related severe toxicity and healthcare visits, independent of the type of systemic treatment received, compared to younger patients. We conclude that select older adults with mUTC can be safely treated with immunotherapy and risk-adjusted regimens of chemotherapy with tangible survival benefits.
由于合并症，转移性泌尿道癌（mUTC）在老年患者中的治疗具有挑战性。我们比较了在三级癌症中心接受一线（1L）全身治疗的年轻和老年（≥70岁）mUTC患者的临床病程。分析了基线临床特征、接受的治疗、耐受性和生存结果。在212例患者中（103例老年患者与109例年轻患者），老年患者基线时血红蛋白水平较低（84%对71%，P = 0.03），大多数不符合顺铂治疗条件（74%对45%，P < 0.001），在一线治疗中接受更多基于免疫疗法的治疗（52%对36%，P = 0.01），接受后续治疗线数较少（中位数0对1，P = 0.003），与年轻患者相比，临床试验参与率较低（30%对18%，P = 0.05）。当接受一线化疗时，老年患者需要更多的剂量调整（53.4%对23%，P = 0.001），接受的化疗周期数较少（中位数4对5，P = 0.01）。与年轻患者相比，老年患者的总生存期相似（11.2个月对14个月，P = 0.06），治疗相关严重毒性和医疗就诊率相似，与所接受的全身治疗类型无关。我们得出结论，部分老年mUTC患者可以安全地接受免疫疗法和风险调整后的化疗方案治疗，并获得切实的生存益处。
