Background: Patients with treatment-naive advanced urothelial cancer (UC) ineligible for cisplatin-based chemotherapy are typically older and have comorbidities, representing a difficult-to-treat population. Objective: To evaluate the safety and antitumor activity of first-line pembrolizumab in subgroups of cisplatin-ineligible older patients (aged 65 and 75 yr) with advanced UC in KEYNOTE-052 (NCT02335424), including those with poor performance status (Eastern Cooperative Oncology Group performance status score 2 [ECOG PS2]). Design, setting, and participants: Patients were cisplatin ineligible, had treatmentnaive, histologically/cytologically confirmed, locally advanced/metastatic UC with measurable disease (Response Evaluation Criteria in Solid Tumors version 1.1 [RECIST v1.1]), and had ECOG PS0–2. Patient subgroups analyzed were aged 65 yr (n = 302), 75 yr (n = 179), 65 yr with ECOG PS2 (65 yr + ECOG PS2; n = 119), and 75 yr + ECOG PS2 (n = 78). Intervention: All patients received pembrolizumab 200 mg intravenously every 3 wk until confirmed progression, intolerable toxicity, patient withdrawal, or 24 mo of therapy. Outcome measurements and statistical analysis: The primary endpoint was objective response rate (ORR) as per RECIST v1.1. The key secondary endpoints were overall survival (OS), duration of response (DOR), and safety. Results and limitations: ORRs for the 65 yr, 75 yr, 65 yr + ECOG PS2, and 75 yr + ECOG PS2 subgroups were 29%, 27%, 29%, and 31%, respectively; rates of complete and partial responses were similar across subgroups (9%, 5%, 6%, and 6%, and 20%, 22%, 23%, and 24%, respectively). Median DOR and OS were also consistent across the 65 yr and 65 yr + ECOG PS2 subgroups and the 75 yr and 75 yr + ECOG PS2 subgroups. Study limitations included open-label design, lack of a comparator group, and nature of post hoc exploratory analysis.

Aged, Bladder cancer, Checkpoint inhibitor, Cisplatin ineligible, Immunotherapy, Programmed death 1, Pembrolizumab, Platinum ineligible, Poor performance status, Urothelial carcinoma,
European Urology Oncology
Department of Medical Oncology

Grivas, P., Plimack, E.R., Balar, A.V., Castellano, D, O'Donnell, P.H., Bellmunt, J, … Vuky, J. (2020). Pembrolizumab as First-line Therapy in Cisplatin-ineligible Advanced Urothelial Cancer (KEYNOTE-052): Outcomes in Older Patients by Age and Performance Status. European Urology Oncology, 3(3), 351–359. doi:10.1016/j.euo.2020.02.009