Top Line: EV-302 established enfortumab vedotin + pembrolizumab (EVP) as a new standard for previously untreated locally advanced/metastatic urothelial carcinoma
The Study: But its trial population was quite fit relative to real-world incidence: 97% had ECOG PS 0-1, and only 24% were 75 or older. A small retrospective series examined 29 patients 80 or older (median age 86, range 80-97): >40% had ECOG PS ≥2 and 31% had GFR ≤30 mL/min. Most patients required a modified EVP regimen, with only 21% starting at the standard EV dose; even still, 45% required dose reduction, and 31% discontinued because of treatment-related toxicity. Nonetheless, the objective response rate was 58%, and median survival just under a year. The accompanying editorial!https://ascopubs.org/doi/10.1200/OP-26-01009 recognizes this as reassuring in deliveringEP to frial patients who clearly want to receive treatment recognizing the unclear absolute benefit amidst dose reduction, but reminds us that best supportive care will remain the preferable alternative for at least some of these “ultraelderly: patients: “Maybe tell them to go home and drink the good wine.”
TBL: EVP can safely be delivered to patients who would have been excluded from the trial that established its efficacy, but dose attenuation and treatment interruptions are common with unestablished resulting impact on efficacy. | Mar, JCO Oncol Pract 2026
The Study: But its trial population was quite fit relative to real-world incidence: 97% had ECOG PS 0-1, and only 24% were 75 or older. A small retrospective series examined 29 patients 80 or older (median age 86, range 80-97): >40% had ECOG PS ≥2 and 31% had GFR ≤30 mL/min. Most patients required a modified EVP regimen, with only 21% starting at the standard EV dose; even still, 45% required dose reduction, and 31% discontinued because of treatment-related toxicity. Nonetheless, the objective response rate was 58%, and median survival just under a year. The accompanying editorial!https://ascopubs.org/doi/10.1200/OP-26-01009 recognizes this as reassuring in deliveringEP to frial patients who clearly want to receive treatment recognizing the unclear absolute benefit amidst dose reduction, but reminds us that best supportive care will remain the preferable alternative for at least some of these “ultraelderly: patients: “Maybe tell them to go home and drink the good wine.”
TBL: EVP can safely be delivered to patients who would have been excluded from the trial that established its efficacy, but dose attenuation and treatment interruptions are common with unestablished resulting impact on efficacy. | Mar, JCO Oncol Pract 2026