@Article{,
AUTHOR = {Evangelia Vlachou, Burles Avner Johnson 3rd, Elizabeth Guancial, Kara A. Lombardo, Jean Hoffman-Censits},
TITLE = {Frontline immune checkpoint inhibitors in patients ≥ 90 years with advanced urothelial cancer: a single center experience},
JOURNAL = {Canadian Journal of Urology},
VOLUME = {31},
YEAR = {2024},
NUMBER = {3},
PAGES = {11875--11879},
URL = {http://www.techscience.com/CJU/v31n3/59584},
ISSN = {1488-5581},
ABSTRACT = {<b>Introduction:</b> Immune checkpoint inhibitors (ICIs) are
approved for advanced urothelial cancer alone and as first
line in combination with enfortumab vedotin. Platinum
based chemotherapy which is another frontline choice is often
not a treatment option for older patients due to comorbidities
that increase with age. Despite ICIs being better tolerated
compared to traditional chemotherapy little is known about
their efficacy and toxicity in patients ≥ 90 years due to the
rarity of this population in clinical trials. Our objective was
to analyze the efficacy and toxicity of immune checkpoint
inhibitors in patients ≥ 90 years.<br/>
<b>Materials and methods:</b> We conducted a single center
retrospective review of patients ≥ 90 years treated between
July 2019 and September 2023 with standard of care ICIs
for advanced urothelial cancer.<br/>
<b>Results:</b> Six patients treated with pembrolizumab were
identified. Four (66.7%) were male and mean age was
93.5 years at the time of treatment initiation. Response
rate was 66.7% (4 patients) with 3 complete responses,
which were durable off therapy. Median follow up was
18.2 months. Median progression free survival (PFS) was
10.2 months [95%confidence interval (95%CI): 1.77, not
reached (NR)] and median overall survival (OS) was 18.2
months (95%CI: 12.1, NR). Side effects presented in 4
(66.7%) patients and included hypothyroidism, diarrhea,
anemia, thrombocytopenia, rash, and bullous dermatitis.
One patient developed grade 3 anemia and no patients
experienced grade 4 events or required hospitalization due
to treatment side effects.<br/>
<b>Conclusions:</b> Our experience in a small cohort of patients
≥ 90 years indicate that ICIs are well tolerated and effective
for the treatment of advanced urothelial carcinoma in this
patient population.},
DOI = {}
}