Challenges in Treating Metastatic Urothelial Cancer: A Geriatric Perspective

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Expert insight into the complexities of managing metastatic urothelial cancer in geriatric patients with comorbidities, highlighting the importance of aggressive therapy in improving survival outcomes.

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
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