Real-world Outcomes of Enfortumab Vedotin in Elderly Patients With Metastatic Urothelial Carcinoma

Background/Aim: Enfortumab vedotin (EV) is an antibody–drug conjugate approved for metastatic urothelial carcinoma (mUC); however, clinical data in elderly patients are limited. Given the increasing use of EV as a first-line or subsequent treatment, assessing its safety and efficacy in older populations is crucial. Patients and Methods: This retrospective, multi-institutional study evaluated the safety and efficacy of EV in patients aged ≥80 years with platinum-refractory mUC. Clinical outcomes were compared with those in patients aged <80 years. Propensity score matching (PSM) was used to minimize selection bias. Results: Among 129 patients included, 25 (19%) were aged ≥80 years. Median follow-up was 7.7 months. There were no significant differences in overall survival (OS: 14.7 vs. 8.9 months, p=0.411), progression-free survival (PFS: 10.2 vs. 6.5 months, p=0.972), or objective response rate (ORR: 56% vs. 46%, p=0.248) between older and younger patients. Rates of treatment discontinuation and dose reduction were comparable between patients aged ≥80 and those aged <80 years, with no statistically significant differences (8% vs. 13%, p=0.529; 28% vs. 21%, p=0.438). Conclusion: EV demonstrated comparable efficacy and tolerability in patients aged ≥80 years relative to younger counterparts. These findings support the safe and effective use of EV in elderly patients with mUC and highlight the need for further prospective studies in this population.