Real-world Outcomes of First-line Platinum-based Chemotherapy in Patients Aged 80 Years or Older With Metastatic Urothelial Carcinoma

Abstract

Background/Aim As populations age, more patients aged ≥80 years with metastatic urothelial carcinoma (mUC) require systemic therapy. However, the efficacy and safety of first-line platinum-based chemotherapy (PBC) in octogenarians remain unclear. This study aimed to describe clinical outcomes in patients aged ≥80 years with mUC eligible for PBC. Patients and Methods We retrospectively analyzed 30 patients with mUC who received first-line PBC between 2005 and 2022. Patient characteristics, tumour response, treatment-related adverse events (TRAEs), and survival outcomes were assessed. Results The median age was 83 (range=80-92) years. The bladder and upper urinary tract were the primary tumour site in 17 and 13 patients, respectively. Performance status was 0 or 1 in 15 patients each. Lymph node–only metastasis was present in 18 patients (60%). Regimens included methotrexate, vinblastine, doxorubicin, and cisplatin in six patients and gemcitabine plus platinum in 24; 15 patients received carboplatin. The median number of cycles was three. The objective response and disease control rates were 40% and 76.7%, respectively. Grade ≥3 TRAEs occurred in 23 patients (76.7%), mainly hematologic toxicities (myelosuppression). Dose reduction was required in 21 patients (70%), and treatment was discontinued in 14 (46.7%) because of toxicity or patient preference (7 each). Median progression-free survival and overall survival were 5.2 and 11.3 months, respectively. Conclusion First-line PBC demonstrated measurable anti-tumour activity in eligible patients aged ≥80 years with mUC. However, myelosuppression often necessitated dose reduction or treatment discontinuation. Thus, PBC in this population warrants careful patient selection and proactive toxicity management.