Challenges in Treating Metastatic Urothelial Cancer: A Geriatric Perspective

Case: A 73-Year-Old Man with Metastatic Urothelial Carcinoma

Initial Clinical Presentation:

• A 73-year-old man presented to you from their local urologist with dizziness and hematuria
• PMH: hypertension and diabetes (uncontrolled)
• SH: former smoker; consumes alcohol 2-3 times per week
• Chest x-ray and CT revealed a 3.7-cm mass on the right lateral wall of the bladder and liver metastases
• Cystoscopic biopsy/pathology confirmed stage IV urothelial carcinoma
• ECOG PS 1
• CrCl 65 mL/min
• The patient received gemcitabine + cisplatin (6 cycles)
  • Partial response at completion of chemotherapy
  • No maintenance therapy given, although discussed with patient

Current Clinical Presentation:

• 7 months later, disease progression was discovered on routine follow up imaging

Treatment:

• The patient received pembrolizumab and a partial response was achieved at 6 cycles
• Molecular testing showed no FGFR2 mutation or fusion