# Treatment Patterns and Outcomes by Age in Metastatic Urinary Tract Cancer: A Retrospective Tertiary Cancer Center Analysis

## TL;DR

Older adults with advanced urinary tract cancer can safely receive tailored treatments like immunotherapy and adjusted chemotherapy, achieving similar survival as younger patients.

## Contribution

The study demonstrates that age alone should not limit treatment choices for older metastatic urinary tract cancer patients.

## Key findings

- Older patients received more immunotherapy and less chemotherapy, with similar survival outcomes as younger patients.
- Older patients required more dose adjustments and fewer chemotherapy cycles but tolerated treatment similarly.
- Clinical trial participation was lower in older patients despite similar healthcare visits and toxicity rates.

## Abstract

Older adults with metastatic cancer of the urinary tract often do not receive optimal cancer treatments. Through our real-world study at a tertiary cancer center, we investigated the clinical characteristics, treatment patterns, and outcomes among older patients compared to younger adults receiving first-line systemic treatment. We found that older patients tend to be more suited to receiving immunotherapy and lower amounts of chemotherapy. When treated with regimens tailored to their overall health, they tolerate treatment as well as younger patients and experience similar life-prolonging benefits from these. Our results further reinforce that age alone is not a predictive factor for survival in patients who receive systemic treatment for advanced cancer. These findings suggest the need for appropriate treatment selection and tailored regimens for older adults with metastatic cancer of the urinary tract.

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%, p = 0.03), the majority were cisplatin-ineligible (74% vs. 45%, p < 0.001), received more immunotherapy-based treatments in the 1L (52% vs. 36%, p = 0.01), received fewer subsequent lines of treatment (median 0 vs. 1, p = 0.003), and had lower clinical trial participation (30% vs. 18%, p = 0.05) compared to the younger patients. When treated with 1L chemotherapy, older patients required more dose adjustments (53.4% vs. 23%, p = 0.001) and received fewer cycles of chemotherapy (median 4 vs. 5, p= 0.01). Older patients had similar OS (11.2 months vs. 14 months, p = 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.