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Urabe F, Tashiro K, Imai Y, Iwatani K, Uchida N, Taneda Y, Shibata K, Hashimoto M, Kawano S, Takiguchi Y, Ohtsuka T, Nakazono M, Kayano S, Atsuta M, Murakami M, Tsuzuki S, Yamamoto T, Yamada H, Miki J, Kimura T. Evaluation of Optimal Sequential Treatment Patterns and Clinical Outcomes in Patients With Advanced Urothelial Carcinoma Treated With First-Line Platinum-Based Chemotherapy: A Multicenter Collaborative Study. Int J Urol 2025. [PMID: 40375459 DOI: 10.1111/iju.70113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2025] [Revised: 04/25/2025] [Accepted: 05/06/2025] [Indexed: 05/18/2025]
Abstract
BACKGROUND Few studies have provided a comprehensive analysis of sequential treatment strategies for locally advanced and metastatic urothelial carcinoma (la/mUC). This study assessed treatment patterns, prognostic factors, and optimal sequencing strategies in patients receiving first-line platinum-based chemotherapy (1 L-PBC). METHODS This retrospective, multicenter study analyzed 212 la/mUC patients who initiated 1 L-PBC. Treatment sequences were categorized based on the therapy, including immune-oncology (IO) drug and enfortumab vedotin (EV) therapy. Multivariate logistic regression identified risk factors for failing to progress to EV therapy. RESULTS The median follow-up duration was 17 months. Of the 212 patients, 65 (38.9%) progressed to EV therapy, achieving the longest median overall survival (OS) of 41 months, compared to 25 months in the 1 L-PBC + IO group and 8 months in the 1 L-PBC group. Poor performance status (ECOG-PS ≥ 1), age ≥ 80 years, and elevated levels of C-reactive protein (≥ 1) were significant predictors of failing to reach EV therapy. Kaplan-Meier analysis indicated no survival difference based on avelumab use in patients with no risk factors, but patients with one or more risk factors receiving avelumab had significantly longer OS than patients who did not receive avelumab. CONCLUSIONS This study emphasizes the prognostic importance of achieving EV therapy and the role of maintenance avelumab in improving outcomes for la/mUC patients with one or more risk factors after 1 L-PBC. Combining EV with pembrolizumab is a promising first-line treatment, and 1 L-PBC remains a viable option for selected patients.
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Affiliation(s)
- Fumihiko Urabe
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei the 3rd Hospital, Tokyo, Japan
| | - Kojiro Tashiro
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei Katsushika Medical Center, Tokyo, Japan
| | - Yu Imai
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Fuji City General Hospital, Shizuoka, Japan
| | - Kosuke Iwatani
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei Kashiwa Hospital, Chiba, Japan
| | - Naoki Uchida
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei Kashiwa Hospital, Chiba, Japan
| | - Yuki Taneda
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Ken Shibata
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, JR Tokyo General Hospital, Tokyo, Japan
| | - Masaki Hashimoto
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei Katsushika Medical Center, Tokyo, Japan
| | - Shota Kawano
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Tokyo-Kita Medical Center, Tokyo, Japan
| | - Yuki Takiguchi
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Atsugi Municipal Hospital, Atsugi, Kanagawa, Japan
| | - Takashi Ohtsuka
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Minoru Nakazono
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Kameda Medical Center, Chiba, Japan
| | - Sotaro Kayano
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, SUBARU Health Insurance Society Ota Memorial Hospital, Ota, Gunma, Japan
| | - Mahito Atsuta
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei Kashiwa Hospital, Chiba, Japan
| | - Masaya Murakami
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Fuji City General Hospital, Shizuoka, Japan
| | - Shunsuke Tsuzuki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Toshihiro Yamamoto
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Tokyo-Kita Medical Center, Tokyo, Japan
| | - Hiroki Yamada
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei Katsushika Medical Center, Tokyo, Japan
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei Kashiwa Hospital, Chiba, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
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2
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Nørgaard M, Mailhac A, Fagerlund K, Strunz-McKendry T, Agerbæk M, Jensen JB. Treatment patterns in patients with locally advanced and metastatic bladder cancer in Denmark 2015-2023 - an updated analysis. Acta Oncol 2025; 64:630-632. [PMID: 40336179 PMCID: PMC12067985 DOI: 10.2340/1651-226x.2025.43484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2025] [Accepted: 04/24/2025] [Indexed: 05/09/2025]
Affiliation(s)
- Mette Nørgaard
- Department of Clinical Epidemiology, Arhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Aurélie Mailhac
- Department of Clinical Epidemiology, Arhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | | | - Mads Agerbæk
- Department of Oncology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jørgen Bjerggaard Jensen
- Department of Urology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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3
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Liang W, Wang Z, Huang Z, Huang Y, Li C, Liang Y, Huang M, Zhang D, Li C. Effectiveness and safety of PD-1/L1 inhibitors as first-line therapy for patients with advanced or metastatic urothelial carcinoma who are ineligible for platinum-based chemotherapy: a meta-analysis. Front Immunol 2025; 16:1430673. [PMID: 40013152 PMCID: PMC11860080 DOI: 10.3389/fimmu.2025.1430673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 01/15/2025] [Indexed: 02/28/2025] Open
Abstract
Objective To evaluate the efficacy and safety of programmed cell death protein 1 or its ligand (PD-1/L1) inhibitors as first-line therapy in advanced or metastatic urothelial carcinoma (mUC) who are ineligible for platinum-based chemotherapy. Method A systematic search was conducted in four databases (Pubmed, Embase, Web of Science, and the Cochrane Library) to find articles that evaluate the effectiveness of first-line PD-1/L1 inhibitors for mUC, from the establishment of the databases to 22 November 2023. Meta-analyses were performed to evaluate the frequencies of progression-free survival (PFS), overall survival (OS), complete response (CR), partial response (PR), stable disease (SD), progressive disease (PD), objective response rate (ORR), disease control rate (DCR), and grade ≥ 3 treatment-related adverse events (trAEs). Results Totally six studies were included for meta-analysis. The CR, PR, SD, PD, ORR, DCR, and grade ≥ 3 trAEs rate were 0.06 [95% confidence interval (CI), 0.04 to 0.07], 0.22 (95% CI, 0.16 to 0.30), 0.27 (95% CI, 0.23 to 0.31), 0.31 (95% CI, 0.20 to 0.44), 0.28 (95% CI, 0.21 to 0.37), 0.57 (95% CI, 0.47 to 0.67) and 0.26 (95% CI, 0.14 to 0.40), respectively. The median PFS and OS were 4.5 months and 13.7 months, respectively. Subgroup analysis showed that PD-1/L1 inhibitors monotherapy had an ORR rate of 0.25 (95% CI, 0.21 to 0.29) and a DCR rate of 0.50(95% CI, 0.44 to 0.56), while PD-1/L1 dual immunotherapy had a better ORR rate of 0.33 (95% CI, 0.15 to 0.52) and a DCR rate of 0.65 (95% CI, 0.49 to 0.80). However, there was no significant difference in PFS and OS between the two groups. Conclusion The findings indicated that PD-1/L1 inhibitors could be used as a safe and viable first-line treatment option for patients with advanced or metastatic urothelial carcinoma who were not suitable candidates for platinum-based chemotherapy. Specifically, the combination of Enfortumab vedotin (EV) and pembrolizumab (Pembro) showed more effectiveness in treating patients compared to trials using the current standard treatment, suggesting that it could be a promising alternative treatment option. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42024510152.
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Affiliation(s)
- Weiming Liang
- Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Zhijing Wang
- Department of Urology, Pu'er People's Hospital, Pu'er, Yunnan, China
| | - Zhilong Huang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Yanping Huang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Chunyan Li
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Yiwen Liang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Miaoyan Huang
- The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Duo Zhang
- Medicine Center, Guangxi University of Science and Technology, Liuzhou, Guangxi, China
| | - Chenchen Li
- Department of Medical Oncology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
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4
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Rizzo M, Morelli F, Ürün Y, Buti S, Park SH, Bourlon MT, Grande E, Massari F, Landmesser J, Poprach A, Takeshita H, Roviello G, Myint ZW, Popovic L, Soares A, Abahssain H, Giannatempo P, Molina‐Cerrillo J, Incorvaia L, Salah S, Zeppellini A, Monteiro FSM, Porta C, Gupta S, Santoni M. Real-Life Impact of Enfortumab Vedotin or Chemotherapy in the Sequential Treatment of Advanced Urothelial Carcinoma: The ARON-2 Retrospective Experience. Cancer Med 2025; 14:e70479. [PMID: 39980145 PMCID: PMC11842279 DOI: 10.1002/cam4.70479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Revised: 11/20/2024] [Accepted: 11/28/2024] [Indexed: 02/22/2025] Open
Abstract
BACKGROUND Recently, a plethora of novel systemic agents have been incorporated into the therapeutic armamentarium of advanced urothelial carcinoma (aUC). The antibody-drug conjugate (ADC), enfortumab vedotin (EV), has demonstrated relevant clinical benefit in patients with aUC refractory to platinum and immune-checkpoint inhibitor (ICI) therapy. Our study provides a retrospective, international, real-world analysis comparing the effectiveness of EV to chemotherapy in this setting. METHODS The data were extracted from the medical records of patients treated with EV or chemotherapy following pembrolizumab for recurrent or progressive aUC after platinum-based chemotherapy. Patients were assessed for overall survival (OS), progression-free survival (PFS), overall response rate (ORR) and duration of response (DoR). RESULTS Our analysis included 247 patients treated with EV (88, 36%) or chemotherapy (159, 64%). Median OS was 9.1 months (95%CI 7.2-10.7) in the overall study population, 13.6 months (95%CI 10.0-31.0) in patients receiving EV and 6.8 months (95%CI 6.0-8.9) in patients receiving chemotherapy (p < 0.001). The OS benefit of EV was not affected by primary tumour site and histology, metastatic sites, type of first platinum-based chemotherapy or response to pembrolizumab. In the EV cohort, the median PFS was significantly longer (8.8 months [95%CI 6.5-17.0] vs. 3.0 months [95%CI 2.6-3.7]) and the ORR was significantly higher (56% vs. 23%) than in the chemotherapy cohort. CONCLUSIONS The results of our international analysis of real-world data confirm the effectiveness of EV in the sequential strategy of aUC patients who have received prior platinum-based chemotherapy and anti-PD-1 pembrolizumab, regardless of commonly considered prognostic factors. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT05290038.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Female
- Humans
- Male
- Middle Aged
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Carcinoma, Transitional Cell/drug therapy
- Carcinoma, Transitional Cell/mortality
- Carcinoma, Transitional Cell/pathology
- Immunoconjugates/therapeutic use
- Immunoconjugates/administration & dosage
- Immunoconjugates/adverse effects
- Progression-Free Survival
- Retrospective Studies
- Treatment Outcome
- Urinary Bladder Neoplasms/drug therapy
- Urinary Bladder Neoplasms/mortality
- Urinary Bladder Neoplasms/pathology
- Urologic Neoplasms/drug therapy
- Urologic Neoplasms/mortality
- Urologic Neoplasms/pathology
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Affiliation(s)
- Mimma Rizzo
- Medical Oncology UnitAzienda Ospedaliera Universitaria Consorziale Policlinico di BariBariItaly
| | - Franco Morelli
- Medical Oncology UnitIRCCS Casa Sollievo della SofferenzaFoggiaItaly
| | - Yüksel Ürün
- Department of Medical Oncology, Faculty of MedicineAnkara UniversityAnkaraTurkey
| | - Sebastiano Buti
- Department of Medicine and SurgeryUniversity of ParmaParmaItaly
- Medical Oncology UnitUniversity Hospital of ParmaParmaItaly
| | - Se Hoon Park
- Samsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Maria T. Bourlon
- Department of Hemato‐Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador ZubiranUniversidad PanamericanaMexico CityMexico
| | - Enrique Grande
- Department of Medical OncologyMD Anderson Cancer Center MadridMadridSpain
| | - Francesco Massari
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
- Medical OncologyIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Johannes Landmesser
- Klinik für UrologieUniversitätsklinikum Schleswig‐Holstein Campus LübeckLübeckGermany
| | - Alexandr Poprach
- Department of Comprehensive Cancer CareMasaryk Memorial Cancer InstituteBrnoCzech Republic
- Faculty of MedicineMasaryk UniversityBrnoCzech Republic
| | - Hideki Takeshita
- Department of Urology, Saitama Medical CenterSaitama Medical UniversitySaitamaJapan
| | - Giandomenico Roviello
- Department of Health Sciences, Section of Clinical Pharmacology and OncologyUniversity of FlorenceFlorenceItaly
| | - Zin W. Myint
- Division of Medical Oncology, Department of Internal Medicine, Markey Cancer CenterUniversity of KentuckyLexingtonKentuckyUSA
| | - Lazar Popovic
- Faculty of Medicine, Oncology Institute of VojvodinaUniversity of Novi SadNovi SadSerbia
| | - Andrey Soares
- Hospital Israelita Albert EinsteinSão PauloBrazil
- Latin American Cooperative Oncology Group–LACOGPorto AlegreBrazil
| | - Halima Abahssain
- Medicine and Pharmacy Faculty, National Institute of Oncology, Medical Oncology UnitMohamed V UniversityRabatMorocco
| | - Patrizia Giannatempo
- Medical Oncology DepartmentFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | | | - Lorena Incorvaia
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), Section of Medical OncologyUniversity of PalermoPalermoItaly
| | - Samer Salah
- Department of Adult Medical OncologyKing Fahad Specialist Hospital‐DammamDammamSaudi Arabia
| | | | | | - Camillo Porta
- Chair of Oncology, Interdisciplinary Department of MedicineUniversity of Bari “Aldo Moro”BariItaly
| | - Shilpa Gupta
- Taussig Cancer InstituteCleveland ClinicClevelandOhioUSA
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5
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Beas-Lozano EL, Remolina-Bonilla YA, Caballero R, Sobrevilla-Moreno N, Perez-Perez P, Díaz-Alvarado MG, Zayas-Villanueva OA, Martinez-Castañeda EA, Campos-Gomez S, Cardoso-Aparicio LA, Mendoza-Oliva D, Bourlon MT. Treatment Patterns for Metastatic Urothelial Carcinoma Across Eight Mexican Centers: The ALEBRIJE Study. JCO Glob Oncol 2025; 11:e2400431. [PMID: 39746168 DOI: 10.1200/go-24-00431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 10/19/2024] [Accepted: 11/14/2024] [Indexed: 01/04/2025] Open
Abstract
PURPOSE Metastatic urothelial carcinoma (mUC) poses a challenge to health care systems, given its treatment complexity and mortality. We aimed to describe the characteristics, treatment patterns, and survival outcomes of Mexican patients with mUC. METHODS A retrospective study was conducted across eight centers for adults with mUC from January /2001 to December 2021. We recorded medical history, eligibility for first-line platinum therapy, treatment lines received, and access to novel drugs. Descriptive statistics were used and survival analysis, including Kaplan-Meier curves and Cox proportional hazards model, was performed. RESULTS We identified 379 patients with mUC; 37 were excluded, and 76% was male, with a median age of 67 years. The median follow-up was 8.4 months. Among those who received a first-line treatment (65%), cisplatin-based chemotherapy (45%) was the most common followed by carboplatin (39%). Causes of cisplatin ineligibility were Eastern Cooperative Oncology Group ≥2 (41%) and glomerular filtration rate <60 mL/min (33%). The overall response rate to up-front platinum therapy was 33%, with a median progression-free survival of 6.1 months (95% CI, 4.9 to 6.9). Second-, third-, and fourth-line treatment was given to 24.6%, 8.8%, and 3.5%, respectively. Chemotherapy was the most common regimen prescribed. Access to novel drugs was limited, 14 patients received avelumab, and 25% received immunotherapy as second-line treatment. The median overall survival was 11.8 months (95% CI, 10.2 to 15.2). Multivariate analysis showed that first-line treatment was independently associated with better survival, whereas poor performance status and visceral disease were associated with worse survival. CONCLUSION To our knowledge, these data represent the first effort to delineate treatment trends of mUC in Mexico. First-line treatment prescription and rates of progression to platinum therapy were higher than those described worldwide. Factors affecting survival included performance status, first-line treatment, and visceral disease. Our study highlights unequal access to novel treatments, underscoring the need for equitable care.
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Affiliation(s)
| | | | - Rosa Caballero
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | | | | | | | | | | | - Maria T Bourlon
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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6
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Kearney M, Kirker M, Thompson A, Gharibian N, Furegato M, Pacheco C, Issa S, Hasanova R, Sciattella P, Scortichini M, Mennini FS. Use of inpatient systemic chemotherapy and/or radiotherapy and related predictive factors, healthcare resource utilization, and direct hospitalization costs for metastatic urothelial cancer: findings from a real-world retrospective observational study derived from the national hospital discharge claims database in Italy. BMC Cancer 2024; 24:1470. [PMID: 39609723 PMCID: PMC11606204 DOI: 10.1186/s12885-024-13075-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 10/17/2024] [Indexed: 11/30/2024] Open
Abstract
BACKGROUND Recent real-world studies revealed high proportions of patients with metastatic urothelial cancer (mUC) do not receive any systemic therapy. This study describes the demographics, clinical characteristics, treatment rate and related predictive factors, healthcare resource utilization, and direct medical costs of patients with mUC receiving systemic therapy (or not) in the inpatient setting in Italy. METHODS This retrospective observational study used the national hospital discharge database (Scheda di Dimissione Ospedaliera) to describe incident adult (≥ 18 years) patients with a first hospitalization for mUC (index) from 2017-2018, identified by a combination of ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification), medical procedure, and diagnosis-related group codes. A model was fitted to identify factors associated with receiving inpatient chemotherapy and/or radiotherapy. RESULTS Of 3674 patients with mUC identified, 1014 (27.6%) were treated with inpatient chemotherapy and/or radiotherapy and 2660 (72.4%) were not treated. The median age at index was 71 and 78 years for treated and untreated patients, and the mean (SD) Charlson Comorbidity Index (CCI) score was 0.3 (0.8) and 0.6 (1.1), respectively. Primary tumor location was the bladder in 87.2% of patients. Cardiovascular disease and renal function impairment were more prevalent in untreated (22.6% and 13.2%) vs treated (16.7% and 7.8%) patients. Older age (odds ratio [p-value]) (0.94 [< 0.001]), female sex (0.82 [0.035]), and higher CCI score (0.82 [< 0.001]) were all associated with a lower likelihood of receiving inpatient systemic treatment. The first year was the costliest: estimated national projected costs during the 36-month follow-up from first hospitalization for mUC were €34.3 million (95% CI, €30.3-€60.0 million) and €31.8 million (95% CI, €28.1-€56.0 million) when estimated after 1 year. CONCLUSIONS Our findings indicate a low rate of inpatient systemic therapy for patients with mUC in Italy (driven by older age, female sex, and high comorbidity burden), with a large economic burden despite a high nontreatment rate. Although this study provides a partial capture of the treatment pathway in Italy, the results are consistent with other European studies with similar designs and highlight the need to better identify the reasons for not administering inpatient systemic chemotherapy and/or radiotherapy.
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Affiliation(s)
- Mairead Kearney
- Merck Healthcare KGaA, Frankfurter Straße 250, 64271, Darmstadt, Germany.
| | | | | | | | - Martina Furegato
- Oracle Life Sciences, 198 Avenue de France, 75013, Paris, France
| | - Cécile Pacheco
- Oracle Life Sciences, 198 Avenue de France, 75013, Paris, France
| | - Seham Issa
- Oracle Life Sciences, 198 Avenue de France, 75013, Paris, France
| | - Reyhan Hasanova
- Oracle Life Sciences, 198 Avenue de France, 75013, Paris, France
| | - Paolo Sciattella
- Economic Evaluation and HTA (EEHTA-CEIS), DEF Department, Faculty of Economics, University of Rome 'Tor Vergata', Via Ulpiano 29, Rome, 00128, Italy
| | - Matteo Scortichini
- Economic Evaluation and HTA (EEHTA-CEIS), DEF Department, Faculty of Economics, University of Rome 'Tor Vergata', Via Ulpiano 29, Rome, 00128, Italy
| | - Francesco Saverio Mennini
- Economic Evaluation and HTA (EEHTA-CEIS), DEF Department, Faculty of Economics, University of Rome 'Tor Vergata', Via Ulpiano 29, Rome, 00128, Italy
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7
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Rizzo A, Monteiro FSM, Ürün Y, Massari F, Park SH, Bourlon MT, Poprach A, Rizzo M, Takeshita H, Giannatempo P, Soares A, Roviello G, Molina-Cerrillo J, Carrozza F, Abahssain H, Messina C, Kopp RM, Pichler R, Formisano L, Tural D, Atzori F, Calabrò F, Kanesvaran R, Buti S, Santoni M. Pembrolizumab in Patients with Advanced Urothelial Carcinoma with ECOG Performance Status 2: A Real-World Study from the ARON-2 Project. Target Oncol 2024; 19:747-755. [PMID: 39107651 DOI: 10.1007/s11523-024-01089-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND The benefit of immune checkpoint inhibitors (ICIs) for poor performance status patients with advanced urothelial carcinoma (UC) remains unknown. OBJECTIVE In the present sub-analysis of the ARON-2 study, we investigated the role of pembrolizumab for advanced UC patients with ECOG (Eastern Cooperative Oncology Group) performance status (ECOG-PS) 2. PATIENTS AND METHODS Patients aged ≥ 18 years with a cytologically and/or histologically confirmed diagnosis of advanced UC progressing or recurring after platinum-based therapy and treated with pembrolizumab between 1 January 2016 to 1 April 2024 were included. In this sub-analysis we focused on patients with ECOG-PS 2. RESULTS We included 1,040 patients from the ARON-2 dataset; of these, 167 patients (16%) presented an ECOG-PS 2. The median overall survival (OS) was 14.8 months (95% confidence interval (CI) 12.5-16.1) in the overall study population, 18.2 months (95% CI 15.8-22.2) in patients with ECOG-PS 0-1, and 3.7 months (95% CI 3.2-5.2) in subjects with ECOG-PS 2 (p < 0.001). The median progression-free survival (PFS) in the overall study population was 5.3 months (95% CI 4.3-97.1), 6.2 months (95% CI 5.5-97.1) in patients with ECOG-PS 0-1, and 2.8 months (95% CI 2.1-3.4) in patients with ECOG-PS 2. Among the latter, liver metastases and progressive disease during first-line therapy were significant predictors of OS at both univariate and multivariate analyses. For PFS, univariate and multivariate analyses showed a prognostic role for lung metastases, liver metastases, and progressive disease during first-line therapy. CONCLUSIONS This large real-world evidence study suggests the effectiveness of second-line pembrolizumab for mUC patients with poor performance status. The presence of liver metastases and progressive disease during first-line therapy is associated with worse clinical outcomes and, thus, should be taken into account when making treatment decisions in clinical practice.
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Affiliation(s)
- Alessandro Rizzo
- S.S.D. C.O.r.O. Bed Management Presa in Carico, TDM, IRCCS Istituto Tumori "Giovanni Paolo II", Viale Orazio Flacco 65, 70124, Bari, Italy.
| | | | - Yüksel Ürün
- Department of Medical Oncology, Faculty of Medicine, Ankara University, 06620, Ankara, Turkey
| | - Francesco Massari
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Se Hoon Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Maria T Bourlon
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
- Escuela de Medicina, Universidad Panamericana, Mexico City, Mexico
| | - Alexandr Poprach
- Masaryk Memorial Cancer Institute, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Mimma Rizzo
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Consorziale Policlinico di Bari, Bari, Italy
| | - Hideki Takeshita
- Department of Urology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Patrizia Giannatempo
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, Milan, Italy
| | - Andrey Soares
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
- Latin American Cooperative Oncology Group - LACOG, Porto Alegre, Brazil
| | - Giandomenico Roviello
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | | | - Francesco Carrozza
- Department of Oncology and Hematology, Oncology Unit, Santa Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy
| | - Halima Abahssain
- Medicine and Pharmacy Faculty, Medical Oncology Unit, National Institute of Oncology, Mohamed V University, Rabat, Morocco
| | | | - Ray Manneh Kopp
- Clinical Oncology, Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia
| | - Renate Pichler
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Luigi Formisano
- Department of Medicine and Surgery, Federico II University, Naples, Italy
| | - Deniz Tural
- Department of Medical Oncology, Bakirköy Dr. SadiKonuk Training and Research Hospital, Istanbul, Türkiye
| | - Francesco Atzori
- Unità di Oncologia Medica, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Fabio Calabrò
- Medical Oncology 1-IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Ravindran Kanesvaran
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Sebastiano Buti
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Matteo Santoni
- Medical Oncology Unit, Macerata Hospital, Macerata, Italy
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8
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Gupta S, Moon HHS, Sridhar SS. A Podcast on Platinum Eligibility and Treatment Sequencing in Platinum-Eligible Patients with Locally Advanced or Metastatic Urothelial Carcinoma. Target Oncol 2024; 19:483-494. [PMID: 38963655 PMCID: PMC11231000 DOI: 10.1007/s11523-024-01074-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 07/05/2024]
Abstract
The treatment landscape for patients with advanced urothelial carcinoma continues to evolve. Enfortumab vedotin plus pembrolizumab has received Food and Drug Administration approval based on recent phase 3 trial data showing superior efficacy compared with first-line platinum-based chemotherapy; however, its distinct toxicity profile may make it less suitable for some patients, and availability in some countries may be limited by cost considerations. Consequently, platinum-based chemotherapy is expected to remain an important first-line treatment option. Choice of platinum regimen (cisplatin- or carboplatin-based) is informed by assessment of clinical characteristics, including performance status, kidney function, and presence of peripheral neuropathy or heart failure. For patients without disease progression after completing platinum-based chemotherapy, avelumab first-line maintenance treatment is recommended by international guidelines. For patients who have disease progression, pembrolizumab is the preferred approach. Additionally, following results from a recent phase 3 trial, nivolumab plus cisplatin-based chemotherapy has also received Food and Drug Administration approval and is an additional first-line treatment option for cisplatin-eligible patients. Later-line options for patients with advanced urothelial carcinoma, depending on prior treatment, may include enfortumab vedotin, erdafitinib (for patients with FGFR2/3 mutations or fusions/rearrangements), sacituzumab govitecan, and platinum rechallenge. For the small proportion of patients ineligible for any platinum-based chemotherapy (i.e., unsuitable for cisplatin or carboplatin), immune checkpoint inhibitor monotherapy with pembrolizumab or atezolizumab is a first-line treatment option, although approved agents vary between countries. In summary, this podcast discusses recent developments in the treatment landscape for advanced urothelial carcinoma, eligibility for platinum-based chemotherapy, potential first-line treatment options, and treatment sequencing. Supplementary file1 (MP4 246907 KB).
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Affiliation(s)
- Shilpa Gupta
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA.
| | - Helen H-S Moon
- Kaiser Permanente Riverside Medical Center, Riverside, CA, USA
| | - Srikala S Sridhar
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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9
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Koshkin VS. Therapy Attrition and Lessons for Future Approaches to Treatment of Advanced Urothelial Cancer. JAMA Netw Open 2024; 7:e249426. [PMID: 38696174 DOI: 10.1001/jamanetworkopen.2024.9426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2025] Open
Affiliation(s)
- Vadim S Koshkin
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco
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10
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Kita Y, Otsuka H, Ito K, Hara T, Shimura S, Kawahara T, Kato M, Kanamaru S, Inoue K, Ito H, Igarashi A, Sazuka T, Takamatsu D, Hashimoto K, Abe T, Naito S, Matsui Y, Nishiyama H, Kitamura H, Kobayashi T, the Japan Urological Oncology Group. Real-world sequential treatment patterns and clinical outcomes among patients with advanced urothelial carcinoma in Japan. Int J Urol 2024; 31:552-559. [PMID: 38303567 PMCID: PMC11524141 DOI: 10.1111/iju.15411] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/21/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVES Immune checkpoint inhibitors and enfortumab vedotin have opened new avenues for sequential treatment strategies for locally advanced/metastatic urothelial carcinoma (la/mUC). In the pre-enfortumab vedotin era, many patients could not receive third-line treatment owing to rapid disease progression and poor general status. This study aimed to analyze real-world sequential treatment practices for la/mUC in Japan, with a focus on patients who do not receive third-line treatment. METHODS We analyzed data for 1023 la/mUC patients diagnosed between January 2020 and December 2021 at 54 institutions from a Japanese nationwide cohort. RESULTS At the median follow-up of 28.5 months, the median overall survival from first-line initiation for 905 patients who received systemic anticancer treatment was 19.1 months. Among them, 81% and 32% received second- and third-line treatment. Notably, 52% had their treatment terminated before the opportunity for third-line treatment. Multivariate logistic regression analysis revealed that low performance status (≥1), elevated neutrophil-to-lymphocyte ratio (≥3), and low body mass index (<21 kg/m2) at the start of first-line treatment were independent risk factors for not proceeding to third-line treatment (p = 0.0024, 0.0069, and 0.0058, respectively). In this cohort, 33% had one of these factors, 36% had two, and 15% had all three. CONCLUSIONS This study highlights the high frequency of factors associated with poor tolerance to anticancer treatment in la/mUC patients. The findings suggest the need to establish optimal sequential treatment strategies, maximizing efficacy within time and tolerance constraints, while concurrently providing strong supportive care, considering immunological and nutritional aspects.
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Affiliation(s)
- Yuki Kita
- Department of UrologyKyoto University Graduate School of MedicineKyotoJapan
| | - Hikari Otsuka
- Department of Urology, Tazuke Kofukai Medical Research InstituteKitano HospitalOsakaJapan
| | - Katsuhiro Ito
- Department of UrologyKyoto University Graduate School of MedicineKyotoJapan
| | - Takuto Hara
- Department of UrologyKobe UniversityKobeJapan
| | | | | | - Minoru Kato
- Department of UrologyOsaka Metropolitan UniversityOsakaJapan
| | - Sojun Kanamaru
- Department of UrologyKobe City Nishi‐Kobe Medical CenterKobeJapan
| | - Koji Inoue
- Department of UrologyKurashiki Central HospitalKurashikiJapan
| | - Hiroki Ito
- Department of UrologyYokohama City UniversityYokohamaJapan
| | - Atsushi Igarashi
- Department of UrologyKobe City Medical Center General HospitalKobeJapan
| | | | | | | | - Takashige Abe
- Department of UrologyHokkaido UniversitySapporoJapan
| | - Sei Naito
- Department of UrologyYamagata UniversityTsuruokaJapan
| | | | | | | | - Takashi Kobayashi
- Department of UrologyKyoto University Graduate School of MedicineKyotoJapan
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11
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Ishihara H, Takagi T. Editorial Comment on Real-world sequential treatment patterns and clinical outcomes among patients with advanced urothelial carcinoma in Japan. Int J Urol 2024; 31:559-560. [PMID: 38366784 DOI: 10.1111/iju.15429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Affiliation(s)
- Hiroki Ishihara
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
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12
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Jones RJ, Crabb SJ, Linch M, Birtle AJ, McGrane J, Enting D, Stevenson R, Liu K, Kularatne B, Hussain SA. Systemic anticancer therapy for urothelial carcinoma: UK oncologists' perspective. Br J Cancer 2024; 130:897-907. [PMID: 38191608 PMCID: PMC10951251 DOI: 10.1038/s41416-023-02543-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/24/2023] [Accepted: 12/01/2023] [Indexed: 01/10/2024] Open
Abstract
Urothelial carcinoma (UC) is a common cancer associated with a poor prognosis in patients with advanced disease. Platinum-based chemotherapy has remained the cornerstone of systemic anticancer treatment for many years, and recent developments in the treatment landscape have improved outcomes. In this review, we provide an overview of systemic treatment for UC, including clinical data supporting the current standard of care at each point in the treatment pathway and author interpretations from a UK perspective. Neoadjuvant cisplatin-based chemotherapy is recommended for eligible patients with muscle-invasive bladder cancer and is preferable to adjuvant treatment. For first-line treatment of advanced UC, platinum-eligible patients should receive cisplatin- or carboplatin-based chemotherapy, followed by avelumab maintenance in those without disease progression. Among patients unable to receive platinum-based chemotherapy, immune checkpoint inhibitor (ICI) treatment is an option for those with programmed death ligand 1 (PD-L1)-positive tumours. Second-line or later treatment options depend on prior treatment, and enfortumab vedotin is preferred after prior ICI and chemotherapy, although availability varies between countries. Additional options include rechallenge with platinum-based chemotherapy, an ICI, or non-platinum-based chemotherapy. Areas of uncertainty include the optimal number of first-line chemotherapy cycles for advanced UC and the value of PD-L1 testing for UC.
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Affiliation(s)
- Robert J Jones
- University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Simon J Crabb
- School of Cancer Sciences, University of Southampton, Southampton, UK
| | - Mark Linch
- UCL Cancer Institute, University College London, London, UK
| | - Alison J Birtle
- Rosemere Cancer Centre, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
- University of Central Lancashire, Lancaster, UK
- University of Manchester, Manchester, UK
| | | | | | | | - Kin Liu
- Merck Serono Ltd., an affiliate of Merck KGaA, Feltham, UK
| | | | - Syed A Hussain
- University of Sheffield and Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
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13
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A Bueno AP, Clark O, Turnure M, Moreira ES, Yuasa A, Sugiyama S, Kirker M, Li S, Hou N, Chang J, Kearney M, Kanas G. Treatment patterns in metastatic bladder cancer in Japan: results of the CancerMPact ® survey 2020. Future Oncol 2024; 20:603-611. [PMID: 38214131 DOI: 10.2217/fon-2023-0197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
Aim: To assess physician-reported treatment of metastatic bladder cancer in Japan. Methods: 76 physicians completed the CancerMPact® survey in July 2020, considering patients treated within 6 months. Results: Physicians treated a mean of 38.1 patients per month. Of cisplatin-eligible and -ineligible patients, 97.6 and 89.3%, respectively, received first-line platinum-based therapy, most commonly cisplatin plus gemcitabine (72.9%) and carboplatin plus gemcitabine (59.7%). 1.6 and 5.6% received first-line immune checkpoint inhibitors, respectively. 48.4 and 45.0%, respectively, progressed and received second-line therapy, most commonly with pembrolizumab (61.7%). Conclusion: In 2020, most patients with metastatic bladder cancer in Japan received first-line platinum-based chemotherapy; however, >50% received no subsequent treatment, highlighting the need for new treatment regimens to improve outcomes and maximize first-line treatment benefits.
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Affiliation(s)
- Ana Paula A Bueno
- Cerner Enviza, An Oracle Company, Av. das Nações Unidas 14171 15º andar, Morumbi São Paulo/SP CEP, 04794-000, Brazil
| | - Otavio Clark
- Cerner Enviza, An Oracle Company, 2300 Oracle Wy, Austin, TX 78741, USA
| | - Matthew Turnure
- Cerner Enviza, An Oracle Company, 2300 Oracle Wy, Austin, TX 78741, USA
| | - Eloisa S Moreira
- Cerner Enviza, An Oracle Company, Av. das Nações Unidas 14171 15º andar, Morumbi São Paulo/SP CEP, 04794-000, Brazil
| | - Akira Yuasa
- Pfizer Japan Inc, 3-22-7 Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan
| | - Shigeru Sugiyama
- Pfizer Japan Inc, 3-22-7 Yoyogi, Shibuya-ku, Tokyo, 151-8589, Japan
| | | | - Si Li
- Pfizer Inc, 235 E 42nd St, New York, NY 10017, USA
| | - Ningqi Hou
- Pfizer Inc, 235 E 42nd St, New York, NY 10017, USA
| | - Jane Chang
- Pfizer Inc, 235 E 42nd St, New York, NY 10017, USA
| | - Mairead Kearney
- Merck Healthcare KGaA, Frankfurter Strasse 250 Darmstadt, 64293, Germany
| | - Gena Kanas
- Cerner Enviza, An Oracle Company, 2300 Oracle Wy, Austin, TX 78741, USA
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14
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Yamamoto S, Kato M, Matsue T, Yukimatsu N, Takeyama Y, Otoshi T, Yamasaki T, Kuratsukuri K, Uchida J. Trend in overall survival from the start of first-line chemotherapy in patients with metastatic urothelial carcinoma. Jpn J Clin Oncol 2024; 54:221-224. [PMID: 37886853 PMCID: PMC10849169 DOI: 10.1093/jjco/hyad151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023] Open
Abstract
New approaches involving immune checkpoint inhibitors and antibody-drug conjugates prolong overall survival in patients with metastatic urothelial carcinoma. However, the access to such systemic therapy in clinical practice is suboptimal, and whether these agents improve overall survival in patients with metastatic urothelial carcinoma over time remains unclear. Hence, we investigated the overall survival trend from the initiation of first-line therapy with these agents to identify changes due to the medication and time of treatment initiation. We retrospectively evaluated 195 patients from a single center. They were treated with chemotherapy, pembrolizumab, or avelumab or enfortumab vedotin. The treatment was categorized into chemotherapy, pembrolizumab or avelumab/enfortumab vedotin period. The new agents prolonged overall survival from the start of first-line therapy. Furthermore, sequential treatment with these agents in real-world clinical practice has been reported to prolong overall survival. These study results will have major implications when a new first-line therapy is approved in the future.
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Affiliation(s)
- Shoma Yamamoto
- Department of Urology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Minoru Kato
- Department of Urology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Taisuke Matsue
- Department of Urology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Nao Yukimatsu
- Department of Urology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yuji Takeyama
- Department of Urology, Ishikiri Seiki Hospital, Osaka, Japan
| | - Taiyo Otoshi
- Department of Urology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Takeshi Yamasaki
- Department of Urology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Katsuyuki Kuratsukuri
- Department of Urology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Junji Uchida
- Department of Urology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
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15
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Minato A, Furubayashi N, Nagata Y, Tomoda T, Masaoka H, Song Y, Hori Y, Kiyoshima K, Negishi T, Kuroiwa K, Seki N, Tomisaki I, Harada K, Nakamura M, Fujimoto N. Prognostic Impact of Histologic Subtype and Divergent Differentiation in Patients with Metastatic Urothelial Carcinoma Treated with Enfortumab Vedotin: A Multicenter Retrospective Study. Curr Oncol 2024; 31:862-871. [PMID: 38392058 PMCID: PMC10888056 DOI: 10.3390/curroncol31020064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/25/2024] [Accepted: 01/31/2024] [Indexed: 02/24/2024] Open
Abstract
Subtype of urothelial carcinoma (SUC), defined here as urothelial carcinoma with any histologic subtype or divergent differentiation, is a clinically aggressive disease. However, the efficacy of enfortumab vedotin (EV) against SUC remains unclear. Hence, this study aimed to assess the oncological outcomes of patients with SUC treated with EV for metastatic disease. We retrospectively evaluated consecutive patients with advanced lower and upper urinary tract cancer who received EV after platinum-based chemotherapy and immune checkpoint blockade therapy at six institutions. The objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) were compared between patients with pure urothelial carcinoma (PUC) and those with SUC. We identified 44 and 18 patients with PUC and SUC, respectively. Squamous differentiation was the most common subtype element, followed by glandular differentiation and sarcomatoid subtype. Although patients with SUC had a comparable ORR to those with PUC, the duration of response for SUC was short. Patients with SUC had poorer PFS than those with PUC; however, no significant difference was observed in OS. Multivariate analysis revealed that SUC was significantly associated with shorter PFS. Although the response of metastatic SUC to EV was similar to that of PUC, SUC showed faster progression than PUC.
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Affiliation(s)
- Akinori Minato
- Department of Urology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan (K.H.); (N.F.)
| | - Nobuki Furubayashi
- Department of Urology, National Hospital Organization Kyushu Cancer Center, Fukuoka 811-1395, Japan; (N.F.)
| | - Yujiro Nagata
- Department of Urology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan (K.H.); (N.F.)
| | - Toshihisa Tomoda
- Department of Urology, Oita Prefectural Hospital, Oita 870-8511, Japan
| | - Hiroyuki Masaoka
- Department of Urology, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka 815-8588, Japan
| | - Yoohyun Song
- Department of Urology, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka 815-8588, Japan
| | - Yoshifumi Hori
- Department of Urology, Miyazaki Prefectural Miyazaki Hospital, Miyazaki 880-8510, Japan
| | - Keijiro Kiyoshima
- Department of Urology, Japanese Red Cross Fukuoka Hospital, Fukuoka 815-8555, Japan
| | - Takahito Negishi
- Department of Urology, National Hospital Organization Kyushu Cancer Center, Fukuoka 811-1395, Japan; (N.F.)
| | - Kentaro Kuroiwa
- Department of Urology, Miyazaki Prefectural Miyazaki Hospital, Miyazaki 880-8510, Japan
| | - Narihito Seki
- Department of Urology, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka 815-8588, Japan
| | - Ikko Tomisaki
- Department of Urology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan (K.H.); (N.F.)
| | - Kenichi Harada
- Department of Urology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan (K.H.); (N.F.)
| | - Motonobu Nakamura
- Department of Urology, National Hospital Organization Kyushu Cancer Center, Fukuoka 811-1395, Japan; (N.F.)
| | - Naohiro Fujimoto
- Department of Urology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan (K.H.); (N.F.)
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16
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Hoffman-Censits J, Grivas P, Powles T, Hawley J, Tyroller K, Seeberger S, Guenther S, Jacob N, Mehr KT, Hahn NM. The JAVELIN Bladder Medley trial: avelumab-based combinations as first-line maintenance in advanced urothelial carcinoma. Future Oncol 2024; 20:179-190. [PMID: 37671748 DOI: 10.2217/fon-2023-0492] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
Results from JAVELIN Bladder 100 established avelumab (anti-PD-L1) first-line maintenance as the standard-of-care treatment for patients with advanced urothelial carcinoma (UC) that has not progressed with first-line platinum-based chemotherapy. We describe the design of JAVELIN Bladder Medley (NCT05327530), an ongoing phase II, multicenter, randomized, open-label, parallel-arm, umbrella trial. Overall, 252 patients with advanced UC who are progression-free following first-line platinum-based chemotherapy will be randomized 1:2:2:2 to receive maintenance therapy with avelumab alone (control group) or combined with sacituzumab govitecan (anti-Trop-2/topoisomerase inhibitor conjugate), M6223 (anti-TIGIT) or NKTR-255 (recombinant human IL-15). Primary end points are progression-free survival per investigator and safety/tolerability of the combination regimens. Secondary end points include overall survival, objective response and duration of response per investigator, and pharmacokinetics.
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Affiliation(s)
- Jean Hoffman-Censits
- Departments of Medical Oncology & Urology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Petros Grivas
- University of Washington, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Thomas Powles
- Department of Genitourinary Oncology, Barts Cancer Institute, Experimental Cancer Medicine Centre, Queen Mary University of London, St Bartholomew's Hospital, London, UK
| | - Jessica Hawley
- University of Washington, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Karin Tyroller
- EMD Serono Research & Development Institute, Inc., Billerica, MA, USA, an affiliate of Merck KGaA
| | | | | | | | | | - Noah M Hahn
- Departments of Medical Oncology & Urology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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17
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Moria FA, Park CL, Eigl BJ, Macfarlane R, Pavic M, Saleh RR. A Real-World Retrospective Analysis of the Management of Advanced Urothelial Carcinoma in Canada. Curr Oncol 2024; 31:704-722. [PMID: 38392046 PMCID: PMC10887988 DOI: 10.3390/curroncol31020052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 02/24/2024] Open
Abstract
Locally advanced or metastatic urothelial carcinoma (aUC) presents a significant challenge with high mortality rates. Platinum-based chemotherapy remains the established frontline standard of care, and a switch-maintenance strategy with immunotherapy has now emerged as a new standard for aUC patients without disease progression, following initial platinum therapy. Examining the treatment patterns is imperative, given the evolving therapeutic landscape. In this study, we conducted a retrospective medical chart review of 17 Canadian oncologists treating patients with aUC to assess unmet needs in Canadian aUC patient care. Data from 146 patient charts were analyzed, revealing important clinical insights about the management of aUC. A substantial proportion of patients (53%) presented with de novo metastatic disease, which was possibly influenced by pandemic-related care disruptions. Variability was evident in the cisplatin eligibility criteria, with a majority (70%) of oncologists utilizing a 50 mL/min threshold. Most favored four cycles of platinum-based chemotherapy to spare the bone marrow for future therapies and prevent patient fatigue. Notably, some eligible patients were kept under surveillance rather than receiving maintenance therapy, suggesting a potential gap in awareness regarding evidence-based recommendations. Furthermore, managing treatment-related adverse events was found to be one of the biggest challenges in relation to maintenance immunotherapy. In conclusion, our findings provide the first comprehensive overview of aUC treatment patterns in Canada following the approval of maintenance immunotherapy, offering insights into the decision-making process and underscoring the importance of evidence-based guidelines in aUC patient management.
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Affiliation(s)
- Feras A. Moria
- McGill University Health Center, Montreal, QC H4A 3J1, Canada; (F.A.M.); (C.L.P.)
| | - Changsu L. Park
- McGill University Health Center, Montreal, QC H4A 3J1, Canada; (F.A.M.); (C.L.P.)
| | | | | | - Michel Pavic
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada;
| | - Ramy R. Saleh
- McGill University Health Center, Montreal, QC H4A 3J1, Canada; (F.A.M.); (C.L.P.)
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18
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Domb C, Garcia JA, Barata PC, Mendiratta P, Rao S, Brown JR. Systematic review of recent advancements in antibody-drug and bicycle toxin conjugates for the treatment of urothelial cancer. Ther Adv Urol 2024; 16:17562872241249073. [PMID: 38779496 PMCID: PMC11110528 DOI: 10.1177/17562872241249073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 04/01/2024] [Indexed: 05/25/2024] Open
Abstract
Antibody-drug conjugates and bicycle toxin conjugates represent a tremendous advance in drug delivery technology and have shown great promise in the treatment of urothelial cancer. Previously approved systemic therapies, including chemotherapy and immunotherapy, are often impractical due to comorbidities, and outcomes for patients with advanced disease remain poor, even when receiving systemic therapy. In this setting, antibody-drug and bicycle toxin conjugates have emerged as novel treatments, dramatically altering the therapeutic landscape. These drugs harness unique designs consisting of antibody or bicycle peptide, linker, and cytotoxic payload with more targeted delivery than conventional chemotherapy, thus eliminating malignant cells while reducing systemic toxicities. Potential targets investigated in urothelial cancer include Nectin-4, TROP2, HER2, and EphA2. Initial clinical trials demonstrated efficacy in treatment of refractory advanced urothelial cancer, as well as improvement in quality of life. These initial studies led to FDA approval of two antibody-drug conjugates, enfortumab vedotin and sacituzumab govitecan. Moreover, antibody-drug and bicycle toxin conjugates are being studied in ongoing clinical trials in frontline treatment of advanced disease as well as for localized cancer. These studies highlight the potential for additional future therapies with novel targets, novel antibodies, cytotoxic and immunomodulatory payloads, and unique structural designs enhancing efficacy and safety. There is increasing evidence that combinations with other cancer therapies, especially immunotherapy, improve treatment outcomes. The combination of enfortumab vedotin and pembrolizumab was recently approved for first-line treatment of advanced urothelial carcinoma. Despite the great promise of these novel drugs, robust predictive biomarkers are needed to determine the patients who would maximally benefit. This review surveys the rationale and current state of the evidence for these new drugs and describes future directions actively being explored.
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Affiliation(s)
- Chaim Domb
- University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Jorge A. Garcia
- University Hospitals Seidman Cancer Center, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - Pedro C. Barata
- University Hospitals Seidman Cancer Center, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - Prateek Mendiratta
- University Hospitals Seidman Cancer Center, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - Santosh Rao
- University Hospitals Seidman Cancer Center, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - Jason R. Brown
- University Hospitals Seidman Cancer Center, 11100 Euclid Ave., Lakeside 1200, Mailstop LKS 5079, Cleveland, OH 44106, USA
- Case Western Reserve University, Cleveland, OH, USA
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Maráz A, Nagy B, Macher T, Jeskó J, Tischler E, Csongvai C, Kearney M. Nationwide Study of Real-World Treatment Patterns and Clinical Outcomes in Patients with Metastatic Urothelial Carcinoma in Hungary. Adv Ther 2023; 40:5475-5488. [PMID: 37831384 PMCID: PMC10611888 DOI: 10.1007/s12325-023-02694-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 09/21/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Data describing real-world treatment patterns in patients with metastatic urothelial carcinoma (mUC) in Central-Eastern Europe are scarce, and data from Hungary have not been published. This retrospective, nationwide, real-world study investigated patient characteristics, treatment patterns, comorbidities, and clinical outcomes in patients with mUC in Hungary. METHODS Adults diagnosed with mUC from January 2016 through June 2021 were identified using the National Health Insurance Fund Administration database. Overall survival (OS) was estimated using the Kaplan-Meier method. RESULTS In total, 2523 patients with mUC were identified. Median follow-up was 7.1 months. Overall, 50% of patients received an identified systemic anticancer treatment; within this subgroup, first-line treatment was platinum-based chemotherapy (PBC) in 86%, non-PBC in 8%, and immune checkpoint inhibitor (ICI) in 6%. The proportion of patients receiving treatment increased from 41% in 2016 to 59% in 2020, driven by increased use of first-line PBC or first-line ICI treatment. Comorbidities were more common in patients receiving first-line ICI treatment vs PBC or non-PBC and in patients receiving carboplatin + gemcitabine vs cisplatin + gemcitabine. Overall, only 24% received a second-line treatment. Unadjusted median OS from the start of first-line treatment in the PBC, non-PBC, and ICI subgroups was 12.8, 7.5, and 6.3 months, respectively. Median OS from date of diagnosis in untreated patients was 7.8 months. OS comparisons adjusted for differences in baseline characteristics between subgroups could not be performed. CONCLUSION To our knowledge, this is the first study to assess treatment patterns in patients with mUC in clinical practice in Hungary, using the national health insurance database. Rates of first- and second-line treatment were consistent with those observed in other countries. Avelumab first-line maintenance treatment became available for reimbursement in Hungary in late 2022, after the study period. Given the evolving landscape of reimbursed treatments in Hungary, further analyses are warranted.
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Affiliation(s)
- Anikó Maráz
- Department of Oncotherapy, University of Szeged, Korányi Fasor 12, H-6720, Szeged, Hungary.
| | - Bence Nagy
- Healthware Consulting Ltd., Budapest, Hungary
| | | | | | - Erika Tischler
- Merck Kft., Budapest, Hungary, an affiliate of Merck KGaA, Darmstadt, Germany
| | - Csaba Csongvai
- Merck Kft., Budapest, Hungary, an affiliate of Merck KGaA, Darmstadt, Germany
| | - Mairead Kearney
- Global Value Demonstration, Market Access and Pricing (GVAP), the healthcare business of Merck KGaA, Darmstadt, Germany
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Kearney M, Zhang L, Hubscher E, Musat M, Harricharan S, Wilke T. Undertreatment in patients with advanced urothelial cancer: systematic literature review and meta-analysis. Future Oncol 2023; 20:1123-1137. [PMID: 37526215 PMCID: PMC11727863 DOI: 10.2217/fon-2023-0298] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/04/2023] [Indexed: 08/02/2023] Open
Abstract
Aim: To assess rates of no systemic treatment (NST), attrition across lines of therapy, and factors influencing treatment selection in patients with locally advanced or metastatic urothelial cancer (la/mUC). Methods: Systematic literature review to identify real-world studies reporting NST or attrition rates in la/mUC from 2017-2022 (including data reported since 2015). Results: Of 2439 publications screened, 29 reported NST rates, ranging from 40-74% in eight European-based studies, 14-60% in 12 US-based studies, and 9-63% in nine studies in other locations (meta-analysis estimate, 39%). Factors associated with NST or no second-line therapy included older age, female sex, poor performance status, poor renal function and distant metastases. Conclusion: A substantial proportion of patients with la/mUC do not receive guideline-recommended treatment.
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Affiliation(s)
| | | | | | | | | | - Thomas Wilke
- Cytel, Waltham, MA, USA
- IPAM e.V., University of Wismar, Wismar, Germany
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21
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Shafique MA, Haseeb A, Siddiq MA, Mussarat A, Rangwala HS, Mustafa MS. Current and Emerging Treatments for Urothelial Carcinoma: A Focus on Enfortumab Vedotin. Cancer Manag Res 2023; 15:699-706. [PMID: 37485038 PMCID: PMC10362867 DOI: 10.2147/cmar.s418009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/17/2023] [Indexed: 07/25/2023] Open
Abstract
Urothelial carcinoma is a common malignancy that affects the urinary system, with bladder cancer being the most prevalent form. Although the management of early-stage disease has seen significant improvements, the treatment of locally advanced and metastatic urothelial carcinoma remains challenging. Over the past decade, there has been an explosion in the number of therapies available for the treatment of advanced disease, with immune checkpoint inhibitors and antibody-drug conjugates leading the way. Enfortumab vedotin is an antibody-drug conjugate that targets Nectin-4, a protein that is overexpressed in urothelial carcinoma cells. In clinical trials, it has shown promising outcomes for the treatment of advanced urothelial carcinoma that has progressed after chemotherapy or immunotherapy. The US Food and Drug Administration has granted expedited approval for enfortumab vedotin in the treatment of advanced urothelial carcinoma. This review provides an overview of the current and emerging treatments for urothelial carcinoma, with a particular focus on enfortumab vedotin. We discuss the mechanisms of action, clinical efficacy, safety, and ongoing research of enfortumab vedotin, along with the current landscape of other approved therapies and promising agents in development. The aim of this review is to provide a comprehensive and up-to-date summary of the available treatment options for urothelial carcinoma, including their limitations and future prospects.
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Affiliation(s)
| | - Abdul Haseeb
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | | | - Abdullah Mussarat
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
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22
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Hoimes CJ, Flaig TW, Milowsky MI, Friedlander TW, Bilen MA, Gupta S, Srinivas S, Merchan JR, McKay RR, Petrylak DP, Sasse C, Moreno BH, Yu Y, Carret AS, Rosenberg JE. Enfortumab Vedotin Plus Pembrolizumab in Previously Untreated Advanced Urothelial Cancer. J Clin Oncol 2023; 41:22-31. [PMID: 36041086 PMCID: PMC10476837 DOI: 10.1200/jco.22.01643] [Citation(s) in RCA: 164] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/22/2022] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Cisplatin-based combination chemotherapy remains the standard of care for locally advanced or metastatic urothelial cancer (la/mUC); however, toxicity is substantial, responses are rarely durable, and many patients with la/mUC are ineligible. Each enfortumab vedotin and pembrolizumab have shown a survival benefit versus chemotherapy in UC, are not restricted by cisplatin eligibility, and warrant investigation as a first-line (1L) combination therapy in patients ineligible for cisplatin. METHODS In this ongoing phase Ib/II, multicenter, open-label study, 1L cisplatin-ineligible patients with la/mUC received enfortumab vedotin 1.25 mg/kg once daily on days 1 and 8 and pembrolizumab 200 mg (day 1) intravenously once daily in 3-week cycles. The primary end point was safety. Key secondary end points included confirmed objective response rate, duration of response (DOR), and overall survival (OS). RESULTS Forty-five patients received enfortumab vedotin plus pembrolizumab. The most common treatment-related adverse events (TRAEs) were peripheral sensory neuropathy (55.6%), fatigue (51.1%), and alopecia (48.9%). Twenty-nine patients (64.4%) had grade 3 or higher TRAEs; the most common were increased lipase (17.8%), maculopapular rash (11.1%), and fatigue (11.1%). One death (2.2%) was classified as a TRAE. The confirmed objective response rate after a median of nine cycles was 73.3% with a complete response rate of 15.6%. The median DOR and median OS were 25.6 months and 26.1 months, respectively. CONCLUSION Enfortumab vedotin plus pembrolizumab showed a manageable safety profile. Most patients experienced tumor shrinkage. The median DOR and median OS exceeding 2 years in a cisplatin-ineligible patient population make this a promising combination currently under investigation in a phase III study (ClinicalTrials.gov identifier: NCT04223856).
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Affiliation(s)
- Christopher J Hoimes
- Duke Cancer Institute, Duke University, Durham, NC
- Seidman Cancer Center at University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH
| | - Thomas W Flaig
- University of Colorado Comprehensive Cancer Center, Aurora, CO
| | - Matthew I Milowsky
- University of North Carolina, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | | | - Shilpa Gupta
- Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH
| | | | | | - Rana R McKay
- University of California San Diego, San Diego, CA
| | | | | | | | | | | | - Jonathan E Rosenberg
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
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23
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Ahmed R, Gupta S. Switch Maintenance Therapy for Metastatic Urothelial Carcinoma. Bladder Cancer 2022; 8:359-369. [PMID: 38994180 PMCID: PMC11181790 DOI: 10.3233/blc-220030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 10/31/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION While switch maintenance therapy is being increasingly investigated in solid tumors, it is a standard in only a few. We conducted a systematic review on switch maintenance therapy for metastatic urothelial carcinoma. EVIDENCE ACQUISITION In this systematic review, we conducted a literature search in PubMed and Cochrane databases up to 2021, based on PRISMA statement guidelines. One hundred and fifty eight articles were identified and after a three-step selection process and six articles, using different agents were included in evidence synthesis. The primary end points were effect on overall survival, progression free survival, safety and tolerability. EVIDENCE SYNTHESIS In the pre-immunotherapy era, targeted therapies like sunitinib, lapatinib and vinflunine were studied as switch maintenance therapy in metastatic urothelial carcinoma but did not show any overall survival benefit. Use of anti-PD-1/PD-L1 agents have shown promise as switch maintenance therapy; pembrolizumab showed improvement in progression free survival in a phase 2 trial and avelumab showed improvement in overall survival and progression free survival in the phase 3 JAVELIN Bladder 100 trial. CONCLUSION Immunotherapy with anti-PD-1/PD-L1 agents has emerged as an effective switch maintenance strategy in patients with metastatic urothelial carcinoma. Intensification of the immunotherapy backbone in this setting can potentially further enhance outcomes. Emerging evidence shows a potential role of Poly (ADP-ribose) polymerase (PARP) inhibitors in this setting as well. Results from ongoing and planned studies will help us understand which switch maintenance approaches would be most effective for improving outcomes in metastatic urothelial carcinoma.
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Affiliation(s)
- Ramsha Ahmed
- Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Shilpa Gupta
- Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA
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24
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Mori K, Schuettfort VM, Yanagisawa T, Katayama S, Pradere B, Laukhtina E, Rajwa P, Mostafaei H, Sari Motlagh R, Quhal F, Moschini M, Soria F, Teoh JYC, D'Andrea D, Abufaraj M, Albisinni S, Krajewski W, Egawa S, Karakiewicz PI, Rink M, Shariat SF. Reassessment of the Efficacy of Carboplatin for Metastatic Urothelial Carcinoma in the Era of Immunotherapy: A Systematic Review and Meta-analysis. Eur Urol Focus 2022; 8:1687-1695. [PMID: 35279408 DOI: 10.1016/j.euf.2022.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/04/2022] [Accepted: 02/23/2022] [Indexed: 01/25/2023]
Abstract
CONTEXT Platinum-based combination chemotherapy is the standard treatment for advanced or metastatic urothelial carcinoma (AMUC). However, data comparing the efficacy of different platinum agents are limited. OBJECTIVE This review aimed to assess the efficacy of carboplatin as a first-line treatment for AMUC using phase 3 randomized trial data. EVIDENCE ACQUISITION Multiple databases were searched for articles published until August 2021. Studies that compared overall survival (OS), complete response (CR), and objective response rates (ORRs) in chemotherapy-eligible patients with AMUC were deemed eligible. EVIDENCE SYNTHESIS Four studies were included. Compared with immune checkpoint inhibitor (ICI) monotherapy, neither cisplatin- nor carboplatin-based chemotherapy was associated with significant OS (hazard ratio [HR]: 0.97, 95% confidence interval [CI]: 0.85-1.11, p = 0.64 and HR: 0.90, 95% CI: 0.78-1.04, p = 0.16, respectively) and CR (odds ratio [OR]: 1.16, 95% CI: 0.70-1.92, p = 0.57 and OR: 0.89, 95% CI: 0.52-1.53, p = 0.67, respectively benefits, while both were associated with a favorable ORR (OR: 0.54, 95% CI: 0.40-0.74, p < 0.001 and OR: 0.58, 95% CI: 0.42-0.80, p < 0.001, respectively). A network meta-analysis (NMA)-based indirect comparison between carboplatin and cisplatin revealed that while cisplatin was slightly better than carboplatin in terms of OS, CR, and ORR, no significant difference was noted. CONCLUSIONS Cisplatin- and carboplatin-based chemotherapies offer similar OS/CR benefits to ICI monotherapy and elicit a greater ORR than ICI monotherapy. Moreover, our NMA demonstrated that both cisplatin- and carboplatin-based chemotherapy have a similar efficacy in terms of OS, CR, and ORR. Given that carboplatin-based chemotherapy is shown to be more effective in contemporary series than in historical controls, it is strongly recommended that carboplatin be re-examined for its value in the era of ICIs and beyond. PATIENT SUMMARY Cisplatin- as well as carboplatin-based chemotherapy is as effective as immune checkpoint inhibitors in terms of survival and eliciting a positive response. It is currently believed that cisplatin provides greater benefits than carboplatin; this requires re-evaluation.
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Affiliation(s)
- Keiichiro Mori
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Victor M Schuettfort
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Takafumi Yanagisawa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Satoshi Katayama
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Hadi Mostafaei
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Sari Motlagh
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahad Quhal
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Marco Moschini
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, University of Studies of Torino, Turin, Italy
| | - Jeremy Y C Teoh
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - David D'Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Mohammad Abufaraj
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Research Division of Urology, Department of Special Surgery, The University of Jordan, Amman, Jordan
| | - Simone Albisinni
- Department of Urology, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Wojciech Krajewski
- Department of Department of Minimally Invasive and Robotic Urology, Wrocław Medical University, Wroclaw, Poland
| | - Shin Egawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan.
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Alimohamed N, Grewal S, Wirtz HS, Hepp Z, Sauvageau S, Boyne DJ, Brenner DR, Cheung WY, Jarada TN. Understanding Treatment Patterns and Outcomes among Patients with De Novo Unresectable Locally Advanced or Metastatic Urothelial Cancer: A Population-Level Retrospective Analysis from Alberta, Canada. Curr Oncol 2022; 29:7587-7597. [PMID: 36290876 PMCID: PMC9600494 DOI: 10.3390/curroncol29100599] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/04/2022] [Accepted: 10/08/2022] [Indexed: 11/06/2022] Open
Abstract
Despite a high disease burden, real-world data on treatment patterns in patients with unresectable locally advanced or metastatic urothelial carcinoma (la/mUC) in Canada are limited. This retrospective, longitudinal cohort study describes treatment patterns and survival in a population of patients with de novo unresectable la/mUC from Alberta, Canada, diagnosed between 1 January 2015 and 31 December 2019, followed until mid-2020. The outcomes of interest were systemic therapy treatment patterns and overall survival (OS). Of 206 patients, most (65.0%, n = 134) did not receive any systemic therapies. Of 72 patients (35.0%) who received first-line systemic therapy, the median duration of treatment was 2.8 months (IQR 3.3). Thirty-five patients (48.6% of those who received first-line therapy) received subsequent second-line therapy, for a median of 3.0 months (IQR 3.3). In all patients (n = 206), the median OS from diagnosis was 5.3 months (95% CI, 4.5-7.0). In patients who received treatment, the median OS from the initiation of first-line and second-line systemic therapy was 9.1 (6.4-11.6) and 4.6 months (3.9-19.2), respectively. The majority of patients did not receive first-line systemic therapy, and, in those who did, survival outcomes were poor. This study highlights the significant unmet need for safe and efficacious therapies for patients with la/mUC in Canada.
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Affiliation(s)
- Nimira Alimohamed
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB T2N 4N2, Canada
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Sayegh N, Tripathi N, Agarwal N, Swami U. Clinical Evidence and Selecting Patients for Treatment with Erdafitinib in Advanced Urothelial Carcinoma. Onco Targets Ther 2022; 15:1047-1055. [PMID: 36186154 PMCID: PMC9522481 DOI: 10.2147/ott.s318332] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/20/2022] [Indexed: 11/23/2022] Open
Abstract
Erdafitinib received accelerated approval on April 12, 2019, for patients with metastatic or locally advanced urothelial carcinoma with susceptible fibroblast growth factor receptor (FGFR) 3 or FGFR2 genetic alterations and who have progressed during or following at least one platinum-based chemotherapy. It thus became the first-ever targeted therapy to receive accelerated FDA approval for metastatic bladder cancer. In the BLC2001 trial, erdafitinib demonstrated an overall response rate of 40% in patients with urothelial carcinoma. Common adverse events include hyperphosphatemia and retinopathy and require regular monitoring. While the increase in serum phosphate levels has been determined to be a pharmacodynamic marker of response, further interrogation of other clinical, genomic, and transcriptomic biomarkers is warranted. Results of the ongoing Phase III trial, THOR, which is comparing erdafitinib to the standard of care (chemotherapy or immunotherapy), are expected to confer full approval. Establishing guidelines for optimal erdafitinib sequencing with immunotherapy and other approved targeted therapies (enfortumab vedotin and sacituzumab govitecan) remains an unmet need.
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Affiliation(s)
- Nicolas Sayegh
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Nishita Tripathi
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Umang Swami
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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27
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Mathew Thomas V, Tripathi N, Agarwal N, Swami U. Current and emerging role of sacituzumab govitecan in the management of urothelial carcinoma. Expert Rev Anticancer Ther 2022; 22:335-341. [PMID: 35249433 DOI: 10.1080/14737140.2022.2049763] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Despite rapid advances in the treatment landscape of urothelial cancer, there is a substantial unmet need for safe and effective therapies for patients with locally advanced and metastatic urothelial cancer. Sacituzumab govitecan (SG) is an antibody-drug conjugate, consisting of a Trop-2 directed monoclonal antibody linked to SN-38, the active metabolite of irinotecan. Trop-2 is a glycoprotein overexpressed in various carcinomas, including urothelial carcinomas. AREAS COVERED We review the available data on SG, including mechanism of action, pharmacology, efficacy, safety, and clinical studies regarding locally advanced or metastatic urothelial cancer. EXPERT OPINION SG performed well in the TROPHY-U-01 phase II trial with an objective response rate of 27%. The most common adverse effects were diarrhea, nausea, fatigue, alopecia, and neutropenia, with the most common grade ≥ 3 treatment-related AEs being neutropenia, leukopenia, anemia, diarrhea, and febrile neutropenia. However, these effects were managed effectively with supportive care. SG currently has an accelerated approval for patients with locally advanced or metastatic urothelial cancer who have received platinum-based chemotherapy and either programmed cell death receptor-1 (PD-1) or programmed death-ligand 1 (PD-L1) inhibitor. Several studies are evaluating SG in urothelial cancers as single-agent or in combination with other agents.
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Affiliation(s)
- Vinay Mathew Thomas
- Division of Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Nishita Tripathi
- Division of Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Neeraj Agarwal
- Division of Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Umang Swami
- Division of Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
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28
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Natesan D, Zhang L, Martell HJ, Jindal T, Devine P, Stohr B, Espinosa-Mendez C, Grenert J, Van Ziffle J, Joseph N, Umetsu S, Onodera C, Turski M, Chan E, Desai A, Aggarwal R, Wong A, Porten S, Chou J, Friedlander T, Fong L, Small EJ, Sweet-Cordero A, Koshkin VS. APOBEC Mutational Signature and Tumor Mutational Burden as Predictors of Clinical Outcomes and Treatment Response in Patients With Advanced Urothelial Cancer. Front Oncol 2022; 12:816706. [PMID: 35321431 PMCID: PMC8935010 DOI: 10.3389/fonc.2022.816706] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/10/2022] [Indexed: 12/21/2022] Open
Abstract
Introduction Tumor mutational burden (TMB) and APOBEC mutational signatures are potential prognostic markers in patients with advanced urothelial carcinoma (aUC). Their utility in predicting outcomes to specific therapies in aUC warrants additional study. Methods We retrospectively reviewed consecutive UC cases assessed with UCSF500, an institutional assay that uses hybrid capture enrichment of target DNA to interrogate 479 common cancer genes. Hypermutated tumors (HM), defined as having TMB ≥10 mutations/Mb, were also assessed for APOBEC mutational signatures, while non-HM (NHM) tumors were not assessed due to low TMB. The logrank test was used to determine if there were differences in overall survival (OS) and progression-free survival (PFS) among patient groups of interest. Results Among 75 aUC patients who had UCSF500 testing, 46 patients were evaluable for TMB, of which 19 patients (41%) had HM tumors and the rest had NHM tumors (27 patients). An additional 29 patients had unknown TMB status. Among 19 HM patients, all 16 patients who were evaluable for analysis had APOBEC signatures. HM patients (N=19) were compared with NHM patients (N=27) and had improved OS from diagnosis (125.3 months vs 35.7 months, p=0.06) but inferior OS for patients treated with chemotherapy (7.0 months vs 13.1 months, p=0.04). Patients with APOBEC (N=16) were compared with remaining 56 patients, comprised of 27 NHM patients and 29 patients with unknown TMB, showing APOBEC patients to have improved OS from diagnosis (125.3 months vs 44.5 months, p=0.05) but inferior OS for patients treated with chemotherapy (7.0 months vs 13.1 months, p=0.05). Neither APOBEC nor HM status were associated with response to immunotherapy. Conclusions In a large, single-institution aUC cohort assessed with UCSF500, an institutional NGS panel, HM tumors were common and all such tumors that were evaluated for mutational signature analysis had APOBEC signatures. APOBEC signatures and high TMB were prognostic of improved OS from diagnosis and both analyses also predicted inferior outcomes with chemotherapy treatment.
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Affiliation(s)
- Divya Natesan
- Helen Diller Family Cancer Center, University of California San Francisco, San Francisco, CA, United States
| | - Li Zhang
- Helen Diller Family Cancer Center, University of California San Francisco, San Francisco, CA, United States
| | - Henry J. Martell
- Department of Pediatrics, Benioff Children’s Hospital, University of California, San Francisco, San Francisco, CA, United States
| | - Tanya Jindal
- Helen Diller Family Cancer Center, University of California San Francisco, San Francisco, CA, United States
| | - Patrick Devine
- Helen Diller Family Cancer Center, University of California San Francisco, San Francisco, CA, United States
| | - Bradley Stohr
- Helen Diller Family Cancer Center, University of California San Francisco, San Francisco, CA, United States
| | - Carlos Espinosa-Mendez
- Department of Pediatrics, Benioff Children’s Hospital, University of California, San Francisco, San Francisco, CA, United States
| | - James Grenert
- Helen Diller Family Cancer Center, University of California San Francisco, San Francisco, CA, United States
| | - Jessica Van Ziffle
- Helen Diller Family Cancer Center, University of California San Francisco, San Francisco, CA, United States
| | - Nancy Joseph
- Helen Diller Family Cancer Center, University of California San Francisco, San Francisco, CA, United States
| | - Sarah Umetsu
- Helen Diller Family Cancer Center, University of California San Francisco, San Francisco, CA, United States
| | - Courtney Onodera
- Helen Diller Family Cancer Center, University of California San Francisco, San Francisco, CA, United States
| | - Michelle Turski
- Helen Diller Family Cancer Center, University of California San Francisco, San Francisco, CA, United States
| | - Emily Chan
- Helen Diller Family Cancer Center, University of California San Francisco, San Francisco, CA, United States
| | - Arpita Desai
- Helen Diller Family Cancer Center, University of California San Francisco, San Francisco, CA, United States
| | - Rahul Aggarwal
- Helen Diller Family Cancer Center, University of California San Francisco, San Francisco, CA, United States
| | - Anthony Wong
- Helen Diller Family Cancer Center, University of California San Francisco, San Francisco, CA, United States
| | - Sima Porten
- Helen Diller Family Cancer Center, University of California San Francisco, San Francisco, CA, United States
| | - Jonathan Chou
- Helen Diller Family Cancer Center, University of California San Francisco, San Francisco, CA, United States
| | - Terence Friedlander
- Helen Diller Family Cancer Center, University of California San Francisco, San Francisco, CA, United States
| | - Lawrence Fong
- Helen Diller Family Cancer Center, University of California San Francisco, San Francisco, CA, United States
| | - Eric J. Small
- Helen Diller Family Cancer Center, University of California San Francisco, San Francisco, CA, United States
| | - Alejandro Sweet-Cordero
- Department of Pediatrics, Benioff Children’s Hospital, University of California, San Francisco, San Francisco, CA, United States
| | - Vadim S. Koshkin
- Helen Diller Family Cancer Center, University of California San Francisco, San Francisco, CA, United States
- *Correspondence: Vadim S. Koshkin,
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Eto M, Lee JL, Chang YH, Gao S, Singh M, Gurney H. Clinical evidence and insights supporting the use of avelumab first-line maintenance treatment in patients with advanced urothelial carcinoma in the Asia-Pacific region. Asia Pac J Clin Oncol 2022; 18:e191-e203. [PMID: 35238147 PMCID: PMC9542411 DOI: 10.1111/ajco.13765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 01/27/2022] [Indexed: 12/01/2022]
Abstract
Until recently, international and Asia-specific guidelines for advanced urothelial carcinoma (UC) recommended first-line (1L) platinum-based chemotherapy, followed by second-line (2L) anti-PD-1 or anti-PD-L1 immune checkpoint inhibitor (ICI) therapy where possible, or 1L ICI therapy in cisplatin-ineligible patients with PD-L1+ tumors. However, long-term outcomes remain poor and only a minority of patients receive 2L therapy. The JAVELIN Bladder 100 trial-which assessed avelumab (anti-PD-L1 antibody) as 1L maintenance therapy plus best supportive care (BSC) versus BSC alone in patients with advanced UC that had not progressed with 1L platinum-based chemotherapy-is the only phase 3 trial of ICI-based treatment in the 1L setting to show significantly improved overall survival, and this treatment approach is now recommended in updated treatment guidelines. Available data from the trial suggest that efficacy and safety in patients enrolled in the Asia-Pacific region were similar to findings in the overall population. In this review, we discuss the treatment of advanced UC, with a specific focus on studies in the Asia-Pacific region, and summarize key findings supporting the use of avelumab 1L maintenance as a standard of care in this setting both in cisplatin-eligible and cisplatin-ineligible patients and irrespective of PD-L1 status.
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Affiliation(s)
- Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jae-Lyun Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | | | - Seasea Gao
- Merck Pte. Ltd., Singapore, an affiliate of Merck KGaA
| | | | - Howard Gurney
- Department of Clinical Medicine, Macquarie University, Sydney, New South Wales, Australia
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Immunotherapy maintenance therapy for advanced urothelial carcinoma (aUC): a comprehensive review. J Cancer Res Clin Oncol 2022; 148:1097-1105. [DOI: 10.1007/s00432-021-03882-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/07/2021] [Indexed: 12/24/2022]
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Koshkin VS, Osbourne AS, Grivas P. Treatment options for advanced urothelial cancer after progression on chemotherapy and immune checkpoint inhibitors: a literature review. Transl Androl Urol 2021; 10:4022-4035. [PMID: 34804845 PMCID: PMC8575584 DOI: 10.21037/tau-21-123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/12/2021] [Indexed: 12/09/2022] Open
Abstract
OBJECTIVE To describe the current treatment landscape in advanced urothelial cancer (aUC)/metastatic urothelial cancer and in particular to review the relevant literature highlighting recent advances in the treatment of patients with aUC after progression on chemotherapy and immune checkpoint inhibitor (ICI). BACKGROUND aUC is a very aggressive disease with poor outcomes. Over the past several years, its treatment landscape has seen significant advances with the approval of ICI and targeted agents, which have led to improved outcomes. The current standard of care for most patients with aUC involves platinum-based chemotherapy followed by ICI after progression or as switch maintenance therapy (if no progression after chemotherapy). Treatment of patients following progression on ICI is more challenging, but novel therapies have been approved, such as erdafitinib for tumors with fibroblast growth factor receptor 2 (FGFR2) or FGFR3 activating mutation or fusion (can also be used following progression on platinum-based chemotherapy), enfortumab vedotin (EV) and sacituzumab govitecan (SG) in an unselected patient population. Many other trials in this space are currently ongoing and other promising agents may also potentially become available in the future. METHODS Narrative overview of the recent literature relevant to the treatment of advanced/metastatic urothelial cancer following progression on chemotherapy and ICI was undertaken. Relevant literature was obtained from review of computerized databases including pubmed.gov and proceedings of major conferences including American Society of clinical Oncology (ASCO) Meetings, GU ASCO Symposia and European Society of Medical Oncology (ESMO) Meetings. CONCLUSIONS In this narrative review, we highlight the current dynamic treatment landscape in aUC, emphasizing the recent important developments and a few examples of ongoing clinical trials. In particular, we focus on therapy options available following progression on platinum-based chemotherapy and ICI, a treatment space where until recently there had been no FDA-approved treatment options. The recent pivotal trials of antibody drug conjugates (ADCs) that led to FDA approvals in this space are highlighted, as are other agents currently in development. We conclude by discussing future directions and ongoing challenges in this evolving disease space.
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Affiliation(s)
- Vadim S. Koshkin
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | | | - Petros Grivas
- Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle Cancer Care Alliance, Seattle, WA, USA
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Monteiro FSM, Silva AGE, Gomes AJPDS, Dutra C, Ferreira NO, Mariano RC, Schutz FA. Erdafitinib treatment in Brazilian patients with metastatic urothelial carcinoma (mUC): real-world evidence from an Expanded Access Program. Ther Adv Med Oncol 2021; 13:17588359211015499. [PMID: 34046088 PMCID: PMC8135201 DOI: 10.1177/17588359211015499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/09/2021] [Indexed: 11/16/2022] Open
Abstract
Background Erdafitinib is the first targeted therapy approved for the treatment of patients with metastatic urothelial carcinoma (mUC). Approval was based on a phase II single-arm trial that demonstrated significant activity of erdafitinib in patients with tumors harboring FGFR2/3 alterations. In Brazil, an Expanded Access Program (EAP) provided patients with early access to erdafitinib prior to market authorization. The current report describes characteristics and outcomes of patients with mUC on erdafitinib therapy. Methods Patients with mUC that failed first- and second-line systemic therapies were screened for FGFR2/3 alterations in primary or metastatic tumor tissues. Patients with FGFR2/3 alterations were selected to receive erdafitinib at the standard dosing schedule and were followed prospectively to evaluate the efficacy and safety outcomes. Results From 19 April 2019, through 13 March 2020, 47 patients with mUC from 10 Brazilian centers were tested for FGFR2/3 alterations. Alterations in FGFR2/3 were found in 12 patients (25.5%) and all of them were eligible for the EAP. Four patients (33%) had partial response, while two patients (17%) had stable disease. Progressive disease, the best response, was observed in five patients (42%). At a median follow-up of 16.2 months, the median time to treatment failure (TTF) was 2.8 months. When considering only patients with objective response, the median TTF was 5.3 months. Adverse events (AEs) were reported for any grade and grade 3 or higher in 10 patients (83%) and 5 patients (42%), respectively. The most common AE was hyperphosphatemia. Conclusion This first real-world evidence report of heavily treated patients with mUC confirms the efficacy and safety of erdafitinib in a disease setting with a lack of treatment options.
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Affiliation(s)
- Fernando Sabino M Monteiro
- Oncology and Hematology Department, Hospital Santa Lucia, SHLS 716 Cj. C, Brasília, DF 70390-700, Brazil
| | - Adriano Gonçalves E Silva
- Latin American Cooperative Oncology Group - LACOG, Genito-Urinary Tumors Section, Porto Alegre, RS, 90619-900, Brazil
| | | | | | | | | | - Fabio A Schutz
- Latin American Cooperative Oncology Group - LACOG, Genito-Urinary Tumors Section, Porto Alegre, RS, Brazil
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