Abstract
Background/aim
Evidence regarding first-line enfortumab vedotin plus pembrolizumab (EVP) in elderly patients with advanced urothelial carcinoma (UC), particularly those aged ≥80 years, remains limited. This study evaluated the real-world effectiveness, safety, and treatment feasibility of EVP stratified by age.Patients and methods
We retrospectively analyzed 40 consecutive patients with unresectable locally advanced or metastatic UC who received first-line EVP at a single institution between December 2024 and April 2026. Outcomes were assessed using predefined age cutoffs of 75 and 80 years. Tumor response was evaluated according to RECIST version 1.1 and adverse events according to CTCAE version 5.0.Results
The median age was 76.2 years, 22 patients (55.0%) were aged ≥75 years and 11 (27.5%) were aged ≥80 years. Patients in the older group were more likely to have lymph node-only disease and lower creatinine clearance. Objective response rates were 52.9% and 77.3% in patients aged Conclusion
In this small, selected real-world cohort, first-line EVP showed preliminary antitumor activity and feasible treatment delivery in elderly patients with advanced UC, including very elderly patients. These findings should be considered hypothesis-generating and require validation in larger studies with longer follow-up and standardized geriatric assessment.