Challenges in Treating Metastatic Urothelial Cancer: A Geriatric Perspective
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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