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Miyake M, Anai S, Iemura Y, Ichikawa K, Miyamoto T, Tomioka A, Kuwada M, Itami Y, Hosokawa Y, Matsumura Y, Okajima E, Torimoto K, Nishimura N, Tomizawa M, Shimizu T, Hori S, Morizawa Y, Gotoh D, Nakai Y, Fujimoto K. A Multicenter, Single-Arm, Prospective Trial to Evaluate Efficacy and Safety of Dose-Dense Methotrexate, Vinblastine, Doxorubicin, and Carboplatin (DD-MVACarbo) Chemotherapy for Cisplatin-Ineligible Patients with Advanced Urothelial Cancer: Study Protocol of the CARBUNCLE Trial. Methods Protoc 2024; 7:58. [PMID: 39195436 DOI: 10.3390/mps7040058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/21/2024] [Accepted: 07/26/2024] [Indexed: 08/29/2024] Open
Abstract
Unresectable, metastatic, advanced urothelial carcinoma (aUC) is an aggressive disease and is treated with platinum-containing first-line chemotherapy, followed by immune checkpoint inhibitors and antibody-drug conjugates. Response to first-line chemotherapy is a vital priority in sequential treatment strategies because a better response to first-line chemotherapy is associated with a better response to subsequent therapies. Gemcitabine plus carboplatin chemotherapy is conventionally recommended for cisplatin-ineligible patients. This multicenter, single-arm prospective trial will investigate whether dose-dense methotrexate, vinblastine, doxorubicin, and carboplatin (DD-MVACarbo) chemotherapy is superior to gemcitabine plus carboplatin chemotherapy in terms of efficacy in platinum-naïve, cisplatin-ineligible patients with aUC. After screening and registration, a total of 46 patients will be treated with this novel chemotherapy regimen. The primary endpoint is the objective response rate. The secondary endpoints include disease control rate, patient-reported outcomes, and adverse events. No evidence of this novel intervention is available as of July 2024. The results are expected to change the standard of care and improve the management of patients with aUC.
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Affiliation(s)
- Makito Miyake
- Department of Urology, Nara Medical University, Kashihara 634-8522, Nara, Japan
| | - Satoshi Anai
- Department of Urology, Nara Prefectural Seiwa Medical Center, Ikoma 636-0802, Nara, Japan
| | - Yusuke Iemura
- Department of Urology, Yamatotakada Municipal Hospital, Yamatotakada 635-8501, Nara, Japan
| | - Kazuki Ichikawa
- Department of Urology, Yamatotakada Municipal Hospital, Yamatotakada 635-8501, Nara, Japan
| | - Tatsuki Miyamoto
- Department of Urology, Takai Hospital, Tenri 632-0006, Nara, Japan
| | - Atsushi Tomioka
- Department of Urology, Saiseikai Chuwa Hospital, Sakurai 633-0054, Nara, Japan
| | - Masaomi Kuwada
- Department of Urology, Matsusaka Chuo General Hospital, Matsusaka 515-0818, Mie, Japan
| | - Yoshitaka Itami
- Department of Urology, Tane General Hospital, Osaka 550-0025, Osaka, Japan
| | - Yukinari Hosokawa
- Department of Urology, Tane General Hospital, Osaka 550-0025, Osaka, Japan
| | | | - Eijiro Okajima
- Department of Urology, Nara City Hospital, Nara 630-8305, Nara, Japan
| | - Kazumasa Torimoto
- Department of Urology, Nara Prefecture General Medical Center, Nara 630-8054, Nara, Japan
| | - Nobutaka Nishimura
- Department of Urology, Nara Medical University, Kashihara 634-8522, Nara, Japan
| | - Mitsuru Tomizawa
- Department of Urology, Nara Medical University, Kashihara 634-8522, Nara, Japan
| | - Takuto Shimizu
- Department of Urology, Nara Medical University, Kashihara 634-8522, Nara, Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, Kashihara 634-8522, Nara, Japan
| | - Yosuke Morizawa
- Department of Urology, Nara Medical University, Kashihara 634-8522, Nara, Japan
| | - Daisuke Gotoh
- Department of Urology, Nara Medical University, Kashihara 634-8522, Nara, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Kashihara 634-8522, Nara, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, Kashihara 634-8522, Nara, Japan
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Nakane K, Taniguchi K, Nezasa M, Enomoto T, Yamada T, Tomioka-Inagawa R, Niwa K, Tomioka M, Ishida T, Nagai S, Yokoi S, Taniguchi T, Kawase M, Kawase K, Iinuma K, Tobisawa Y, Koie T. Oncologic Outcomes of Patients with Immune Checkpoint Inhibitor Resistant Urothelial Carcinoma Treated with Enfortumab Vedotin and the Impact of Neutrophil-to-Lymphocyte Ratio and Dysgeusia on Overall Survival: A Retrospective Multicenter Cohort Study in Japan. Cancers (Basel) 2024; 16:2648. [PMID: 39123376 PMCID: PMC11312170 DOI: 10.3390/cancers16152648] [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: 06/19/2024] [Revised: 07/20/2024] [Accepted: 07/24/2024] [Indexed: 08/12/2024] Open
Abstract
Randomized phase III trial results have demonstrated enfortumab vedotin (EV), an antibody-drug conjugate (ADC) consisting of an anti-Nectin-4 human IgG1 monoclonal antibody and monomethyl auristatin E, is a useful treatment for patients with locally advanced or metastatic urothelial carcinoma (la/mUC) that progressed after immune checkpoint inhibitor (ICI) therapies. This multicenter retrospective cohort study aimed to identify predictive factors for the efficacy of EV therapy and prolonged overall survival (OS) of patients in clinical practice. This study included patients with la/mUC who received ICI treatment. Patients who subsequently received EV treatment, those who received non-EV chemotherapy, and those who received no treatment were defined as EV, non-EV, and best supportive care (BSC) groups, respectively. The median OS was 20, 15, and 7 months in the EV, non-EV, and BSC groups, respectively (p < 0.001). Patients with la/mUC who had a complete or partial response after EV treatment had a significantly prolonged OS compared with those with stable or progressive disease. Univariate analysis showed age, neutrophil-to-lymphocyte ratio (NLR), dysgeusia, and rash as independent predictors of OS improvement. NLR and dysgeusia were independent predictors of OS after EV in multivariate analysis. Patients without these factors had a significantly prolonged OS compared to those with both factors. In real-world practice, EV therapy is an effective treatment for patients with la/mUC after ICI treatment.
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Affiliation(s)
- Keita Nakane
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (K.N.); (T.E.); (M.T.); (T.T.); (M.K.); (K.K.); (K.I.); (Y.T.)
| | - Kazuki Taniguchi
- Department of Urology, Gifu Prefectural General Medical Center, Gifu 5008717, Japan;
| | - Minori Nezasa
- Department of Urology, Matsunami General Hospital, Gifu 5016062, Japan;
| | - Torai Enomoto
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (K.N.); (T.E.); (M.T.); (T.T.); (M.K.); (K.K.); (K.I.); (Y.T.)
- Department of Urology, Matsunami General Hospital, Gifu 5016062, Japan;
| | - Toyohiro Yamada
- Department of Urology, Ogaki Municipal Hospital, Ogaki 5038502, Japan;
| | - Risa Tomioka-Inagawa
- Department of Urology, Japanese Red Cross Takayama Hospital, Takayama 5068550, Japan;
| | - Kojiro Niwa
- Department of Urology, Daiyukai Daiichi Hospital, Ichinomiya 4918551, Japan;
| | - Masayuki Tomioka
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (K.N.); (T.E.); (M.T.); (T.T.); (M.K.); (K.K.); (K.I.); (Y.T.)
- Department of Urology, Chuno Kosei Hospital, Seki 5013802, Japan
| | - Takashi Ishida
- Department of Urology, Gifu Municipal Hospital, Gifu 5008513, Japan;
| | - Shingo Nagai
- Department of Urology, Toyota Memorial Hospital, Toyota 4718513, Japan;
| | - Shigeaki Yokoi
- Department of Urology, Central Japan International Medical Center, Minokamo 5058510, Japan;
| | - Tomoki Taniguchi
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (K.N.); (T.E.); (M.T.); (T.T.); (M.K.); (K.K.); (K.I.); (Y.T.)
| | - Makoto Kawase
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (K.N.); (T.E.); (M.T.); (T.T.); (M.K.); (K.K.); (K.I.); (Y.T.)
| | - Kota Kawase
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (K.N.); (T.E.); (M.T.); (T.T.); (M.K.); (K.K.); (K.I.); (Y.T.)
| | - Koji Iinuma
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (K.N.); (T.E.); (M.T.); (T.T.); (M.K.); (K.K.); (K.I.); (Y.T.)
| | - Yuki Tobisawa
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (K.N.); (T.E.); (M.T.); (T.T.); (M.K.); (K.K.); (K.I.); (Y.T.)
| | - Takuya Koie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan; (K.N.); (T.E.); (M.T.); (T.T.); (M.K.); (K.K.); (K.I.); (Y.T.)
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