Outcomes with atezolizumab in metastatic urothelial cancer: real-world data from a single institution.
Atezolizumab
Bladder cancer
Immune checkpoint inhibitors
Real-world data
Journal
Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico
ISSN: 1699-3055
Titre abrégé: Clin Transl Oncol
Pays: Italy
ID NLM: 101247119
Informations de publication
Date de publication:
04 Aug 2023
04 Aug 2023
Historique:
received:
02
06
2023
accepted:
17
07
2023
medline:
4
8
2023
pubmed:
4
8
2023
entrez:
3
8
2023
Statut:
aheadofprint
Résumé
Immune checkpoint inhibitors (ICIs) have been incorporated in the treatment of metastatic urothelial carcinoma (mUC) upon platinum-based chemotherapy according to the positive results of large clinical trials. Nevertheless, results from unselected populations reflecting real-world data (RWD) are highly informative to the clinician. We reviewed daily clinical practice outcomes in patients with mUC who received atezolizumab in our institution. Here we evaluated the clinical activity and safety of atezolizumab in an unselected population of mUC patients who received atezolizumab between 2018 and 2022 reflecting RWD. Efficacy and safety information were retrospectively collected. A total of 63 patients were included. The mean age was 68 years and the objective response rate was 14.3%. The median progression-free survival was 3 months and the median overall survival 6 months. At 1 year, 42% of the patients were alive. ECOG (0 vs 1) and neutrophil-lymphocytes ratio < 2 at the start of ICI were positive prognostic factors that discriminated between long vs short survivors. Overall tolerance was good with no new safety signals. Five patients (17%) had treatment-related adverse events grade ≥ 2 that required corticosteroids. In this retrospective study, atezolizumab was an effective and tolerable treatment option for patients with mUC after progression to platinum-based chemotherapy. Yet, patient selection remains critical to improve outcomes.
Identifiants
pubmed: 37537512
doi: 10.1007/s12094-023-03288-1
pii: 10.1007/s12094-023-03288-1
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. The Author(s), under exclusive licence to Federación de Sociedades Españolas de Oncología (FESEO).
Références
WHO Cancer Mortality Databse. In: https://gco.iarc.fr/today/data/factsheets/cancers/30-Bladder-fact-sheet.pdf . Accesed 26 Feb 2023
Bedke J, Albiges L, Capitanio U, Giles RH, Hora M, Ljunberg B, et al. The 2022 updated European association of urology guidelines on the use of adjuvant immune checkpoint inhibitor therapy for renal cell carcinoma. Eur Urol. 2023;83(1):10–4. https://doi.org/10.1016/j.eururo.2022.10.010 .
doi: 10.1016/j.eururo.2022.10.010
pubmed: 36511268
Valderrama BP, González-Del-Alba A, Morales-Barrera R, Peláez Fernández I, Vázquez S, Caballero Díaz C, et al. SEOM-SOGUG clinical guideline for localized muscle invasive and advanced bladder cancer (2021). Clin Transl Oncol. 2022;24(4):613–24. https://doi.org/10.1007/s12094-022-02815-w .
doi: 10.1007/s12094-022-02815-w
pubmed: 35347572
pmcid: 8986688
Freedman ND, Silverman DT, Hollenbeck AR, Schatzkin A, Abnet CC. Association between smoking and risk of bladder cancer among men and women. JAMA. 2011;306(7):737–45. https://doi.org/10.1001/jama.2011.1142 .
doi: 10.1001/jama.2011.1142
pubmed: 21846855
pmcid: 3441175
Liu S, Yang T, Na R, Hu M, Zhang FuY, et al. The impact of female gender on bladder cancer-specific death risk after radical cystectomy: a meta-analysis of 27912 patients. Int Urol Nephrol. 2015;47(6):951–8. https://doi.org/10.1007/s11255-015-0980-6 .
doi: 10.1007/s11255-015-0980-6
pubmed: 25894962
Shi ZD, Hao L, Han XX, Wu ZX, Pang K, Dong Y, et al. Targeting HNRNPU to overcome cisplatin resistance in bladder cancer. Mol Cancer. 2022;21(1):37. https://doi.org/10.1186/s12943-022-01517-9 .
doi: 10.1186/s12943-022-01517-9
pubmed: 35130920
pmcid: 8819945
Mollica V, Rizzo A, Montironi R, Cheng L, Giunchi F, Schiavina R, et al. Current strategies and novel therapeutic approaches for metastatic urothelial carcinoma. Cancers (Basel). 2020;12(6):1449. https://doi.org/10.3390/cancers12061449 .
doi: 10.3390/cancers12061449
pubmed: 32498352
Kamat AM, Hahn NM, Efstathiou JA, Lerner SP, Malmström PU, Choi W, et al. Bladder cancer. Lancet. 2016;388(10061):2796–810. https://doi.org/10.1016/S0140-6736(16)30512-8 .
doi: 10.1016/S0140-6736(16)30512-8
pubmed: 27345655
Chierigo F, Wenzel M, Würnschimmel C, Flammia RS, Horlemann B, Tian Z, et al. Immuno-oncology therapy in metastatic bladder cancer: A systematic review and network meta-analysis. Crit Rev Oncol Hematol. 2022. https://doi.org/10.1016/j.critrevonc.2021.103534 .
doi: 10.1016/j.critrevonc.2021.103534
pubmed: 34823022
Powles T, Durán I, van der Heijden MS, Loriot Y, Vogelzang NJ, De Giorgi U, et al. Atezolizumab versus chemotherapy in patients with platinum-treated locally advanced or metastatic urothelial carcinoma (IMvigor211): a multicentre, open-label, phase 3 randomised controlled trial. Lancet. 2018;391(10122):748–57. https://doi.org/10.1016/S0140-6736(17)33297-X .
doi: 10.1016/S0140-6736(17)33297-X
pubmed: 29268948
Bellmunt J, de Wit R, Vaughn DJ, Fradet Y, Lee JL, Fong L, et al. KEYNOTE-045 investigators pembrolizumab as second-line therapy for advanced urothelial Carcinoma. N Engl J Med. 2017. https://doi.org/10.1056/NEJMoa1613683 .
doi: 10.1056/NEJMoa1613683
pubmed: 28591526
pmcid: 5635424
Sharma P, Retz M, Siefker-Radtke A, Baron A, Necchi A, Bedke J, et al. Nivolumab in metastatic urothelial carcinoma after platinum therapy (CheckMate 275): a multicentre, single-arm, phase 2 trial. Lancet Oncol. 2017;18(3):312–22. https://doi.org/10.1016/S1470-2045(17)30065-7 .
doi: 10.1016/S1470-2045(17)30065-7
pubmed: 28131785
Balar AV, Castellano DE, Grivas P, Vaughn DJ, Powles T, Vuky J, et al. Efficacy and safety of pembrolizumab in metastatic urothelial carcinoma: results from KEYNOTE-045 and KEYNOTE-052 after up to 5 years of follow-up. Ann Oncol. 2023;34(3):289–99. https://doi.org/10.1016/j.annonc.2022.11.012 .
doi: 10.1016/j.annonc.2022.11.012
pubmed: 36494006
Van der Heijden MS, Loriot Y, Durán I, Ravaud A, Retz M, Vogelzang NJ, et al. Atezolizumab versus chemotherapy in patients with platinum-treated locally advanced or metastatic urothelial carcinoma: a long-term overall survival and safety update from the phase 3 IMvigor211 clinical trial. Eur Urol. 2021;80(1):7–11. https://doi.org/10.1016/j.eururo.2021.03.024 .
doi: 10.1016/j.eururo.2021.03.024
pubmed: 33902955
Sternberg CN, Loriot Y, James N, Choy E, Castellano D, Lopez-Rios F, et al. Primary results from SAUL, a multinational single-arm safety study of Atezolizumab therapy for locally advanced or metastatic urothelial or nonurothelial carcinoma of the urinary tract. Eur Urol. 2019;76(1):73–81. https://doi.org/10.1016/j.eururo.2019.03.015 .
doi: 10.1016/j.eururo.2019.03.015
pubmed: 30910346
Powles T, Park SH, Voog E, Caserta C, Valderrama B, Gurney H, et al. Avelumab maintenance therapy for advanced or metastatic Urothelial Carcinoma. N Engl J Med. 2020;383(13):1218–30. https://doi.org/10.1056/NEJMoa2002788 .
doi: 10.1056/NEJMoa2002788
pubmed: 32945632
Bamias A, Merseburger AS, Loriot Y, James N, Choy E, Castellano D, et al. SAUL, a single-arm study of atezolizumab for chemotherapy-pretreated locally advanced or metastatic carcinoma of the urinary tract: outcomes by key baseline factors, PD-L1 expression and prior platinum therapy. ESMO Open. 2021. https://doi.org/10.1016/j.esmoop.2021.100152 .
doi: 10.1016/j.esmoop.2021.100152
pubmed: 34450475
pmcid: 8390550
Sonpavde G, Manitz J, Gao C, Tayama D, Kaiser C, Hennessy D, et al. Five-factor prognostic model for survival of post-platinum patients with metastatic urothelial carcinoma receiving PD-L1 inhibitors. J Urol. 2020;204(6):1173–9. https://doi.org/10.1097/JU.0000000000001199 .
doi: 10.1097/JU.0000000000001199
pubmed: 32552295
pmcid: 7655635
Galsky M, Witjes JA, Gschwend JE, Schenker M, Valderrama BP, Tomita Y, et al. PD10–01 disease-free survival with longer follow-up from the checkmate 274 trial of adjuvant Nivolumab in patients after surgery for high-risk muscle-invasive urothelial carcinoma. J Urology. 2022. https://doi.org/10.1097/JU.0000000000002536.01 .
doi: 10.1097/JU.0000000000002536.01
Khaki AR, Li A, Diamantopoulos LN, Bilen MA, Santos V, Esther J, et al. Impact of performance status on treatment outcomes: a real-world study of advanced urothelial cancer treated with immune checkpoint inhibitors. Cancer. 2020;126(6):1208–16. https://doi.org/10.1002/cncr.32645 .
doi: 10.1002/cncr.32645
pubmed: 31829450
Swami U, Haaland B, Kessel A, Nussenzveig R, Maughan BL, Esther J, et al. Comparative effectiveness of immune checkpoint inhibitors in patients with platinum refractory advanced urothelial carcinoma. J Urol. 2021;205(3):709–17. https://doi.org/10.1097/JU.0000000000001412 .
doi: 10.1097/JU.0000000000001412
pubmed: 33080152
Sotelo M, Alonso-Gordoa T, Gajate P, Gallardo E, Morales-Barrera R, Pérez-Gracia JL, et al. Atezolizumab in locally advanced or metastatic urothelial cancer: a pooled analysis from the Spanish patients of the IMvigor 210 cohort 2 and 211 studies. Clin Transl Oncol. 2021;23(4):882–91. https://doi.org/10.1007/s12094-020-02482-9 .
doi: 10.1007/s12094-020-02482-9
pubmed: 32897497
Pond GR, Agarwal A, Ornstein M, Garcia J, Gupta R, Grivas P, et al. Clinical outcomes of platinum-ineligible patients with advanced urothelial carcinoma treated with first-line PD1/L1 inhibitors. Clin Genitourin Cancer. 2021;19(5):425–33. https://doi.org/10.1016/j.clgc.2021.04.008 .
doi: 10.1016/j.clgc.2021.04.008
pubmed: 34006497