# Baseline geriatric 8 (G8) screening tool predicts overall survival in metastatic urothelial carcinoma treated with immune checkpoint inhibitors

## TL;DR

The Geriatric 8 (G8) tool helps predict survival in older patients with advanced bladder cancer treated with immunotherapy.

## Contribution

This study shows the G8 screening tool can predict overall survival in elderly patients with metastatic urothelial carcinoma treated with immune checkpoint inhibitors.

## Key findings

- Lower G8 scores were associated with worse overall survival in patients with metastatic urothelial carcinoma.
- The G8 tool may help guide treatment decisions for older patients receiving immunotherapy.
- Frail patients identified by G8 scores had significantly worse survival outcomes.

## Abstract

Metastatic urothelial carcinoma (mUC) remains highly lethal despite advances in treatment. There is limited data surrounding the efficacy and toxicity of immune checkpoint inhibitors in treating elderly patients due to the high bar of clinical trial participation. The Geriatric 8 (G8) screening tool is a quick, 8-item questionnaire designed to assess frailty in older adults. This study evaluates the G8 tool’s utility in predicting overall survival (OS) and progression-free survival (PFS) in patients with mUC treated with immune checkpoint inhibitors.

A retrospective analysis was conducted on 48 mUC patients treated with ICI monotherapy at Winship Cancer Institute between 2016 and 2019. Baseline G8 scores were calculated from clinical notes. Primary outcomes included OS and PFS, analyzed using Kaplan-Meier, Cox proportional hazards models, and multivariate analysis adjusted for demographic and clinical variables.

An impaired baseline G8 score predicted worse OS but not PFS. The incidence of immune-related adverse events was lower but not statistically significant in patients with impaired G8 scores (HR, 0.31; OR, 0.09-1.14; P = .077).

The G8 screening tool effectively predicts OS in older mUC patients treated with ICIs, highlighting its potential utility in clinical decision-making. Frail patients, as identified by the G8, had significantly worse survival outcomes, underscoring the need for tailored therapeutic approaches in this vulnerable population. Further studies are warranted to validate these findings and explore interventions that may improve outcomes for frail, older patients with mUC.