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Shimizu T, Miyake M, Nishimura N, Inoue K, Fujii K, Iemura Y, Ichikawa K, Omori C, Tomizawa M, Maesaka F, Oda Y, Miyamoto T, Sakamoto K, Kiba K, Tanaka M, Oyama N, Okajima E, Fujimoto K, Hori S, Morizawa Y, Gotoh D, Nakai Y, Torimoto K, Tanaka N, Fujimoto K. Organ-Specific and Mixed Responses to Pembrolizumab in Patients with Unresectable or Metastatic Urothelial Carcinoma: A Multicenter Retrospective Study. Cancers (Basel) 2022; 14:cancers14071735. [PMID: 35406508 PMCID: PMC8997142 DOI: 10.3390/cancers14071735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 11/16/2022] Open
Abstract
To investigate the organ-specific response and clinical outcomes of mixed responses (MRs) to immune checkpoint inhibitors (ICIs) for unresectable or metastatic urothelial carcinoma (ur/mUC), we retrospectively analyzed 136 patients who received pembrolizumab. The total objective response rate (ORR) and organ-specific ORR were determined for each lesion according to the Response Evaluation Criteria in Solid Tumors version 1.1 as follows: (i) complete response (CR), (ii) partial response (PR), (iii) stable disease (SD), and (iv) progressive disease (PD). Most of the organ-specific ORR was 30−40%, but bone metastasis was only 5%. There was a significant difference in overall survival (OS) between responders and non-responders with locally advanced lesions and lymph node, lung, or liver metastases (HR 9.02 (3.63−22.4) p < 0.0001; HR 3.63 (1.97−6.69), p < 0.0001; HR 2.75 (1.35−5.59), p = 0.0053; and HR 3.17 (1.00−10.0), p = 0.049, respectively). MR was defined as occurring when PD happened in one lesion plus either CR or PR occurred in another lesion simultaneously, and 12 cases were applicable. MR was significantly associated with a poorer prognosis than that of the responder group (CR or PR; HR 0.09 (0.02−0.35), p = 0.004). Patients with bone metastases benefitted less. Care may be needed to treat patients with MR as well as patients with pure PD. Further studies should be conducted in the future.
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Affiliation(s)
- Takuto Shimizu
- Department of Urology, Nara Medical University, Kashihara 634-8522, Japan; (T.S.); (K.I.); (K.S.); (S.H.); (Y.M.); (D.G.); (Y.N.); (K.T.); (K.F.)
| | - Makito Miyake
- Department of Urology, Nara Medical University, Kashihara 634-8522, Japan; (T.S.); (K.I.); (K.S.); (S.H.); (Y.M.); (D.G.); (Y.N.); (K.T.); (K.F.)
- Correspondence: ; Tel.: +81-744-22-3051; Fax: +81-744-22-9282
| | - Nobutaka Nishimura
- Department of Urology, Okanami General Hospital, Iga 518-0842, Japan; (N.N.); (K.F.)
| | - Kuniaki Inoue
- Department of Urology, Nara Medical University, Kashihara 634-8522, Japan; (T.S.); (K.I.); (K.S.); (S.H.); (Y.M.); (D.G.); (Y.N.); (K.T.); (K.F.)
| | - Koyo Fujii
- Department of Urology, Osaka Gyoumeikan Hospital, Osaka 554-0012, Japan;
| | - Yusuke Iemura
- Department of Urology, Hirao Hospital, Kashihara 634-0076, Japan;
| | - Kazuki Ichikawa
- Department of Urology, Takai Hospital, Tenri 632-0372, Japan;
| | - Chihiro Omori
- Department of Urology, Nara Prefecture General Medical Center, Nara 630-8581, Japan;
| | - Mitsuru Tomizawa
- Department of Urology, Yamato Takada Municipal Hospital, Yamato Takada 635-8501, Japan;
| | - Fumisato Maesaka
- Department of Urology, Nara City Hospital, Nara 630-8305, Japan; (F.M.); (E.O.)
| | - Yuki Oda
- Department of Urology, Nara Prefecture Seiwa Medical Center, Ikoma 636-0802, Japan; (Y.O.); (N.O.)
| | - Tatsuki Miyamoto
- Department of Urology, Hoshigaoka Medical Center, Hirakata 573-8511, Japan;
| | - Keiichi Sakamoto
- Department of Urology, Nara Medical University, Kashihara 634-8522, Japan; (T.S.); (K.I.); (K.S.); (S.H.); (Y.M.); (D.G.); (Y.N.); (K.T.); (K.F.)
| | - Keisuke Kiba
- Department of Urology, Kindai University Nara Hospital, Ikoma 630-0293, Japan;
| | - Masahiro Tanaka
- Department of Urology, Osaka Kaisei Hospital, Osaka 532-0003, Japan;
| | - Nobuo Oyama
- Department of Urology, Nara Prefecture Seiwa Medical Center, Ikoma 636-0802, Japan; (Y.O.); (N.O.)
| | - Eijiro Okajima
- Department of Urology, Nara City Hospital, Nara 630-8305, Japan; (F.M.); (E.O.)
| | - Ken Fujimoto
- Department of Urology, Okanami General Hospital, Iga 518-0842, Japan; (N.N.); (K.F.)
| | - Shunta Hori
- Department of Urology, Nara Medical University, Kashihara 634-8522, Japan; (T.S.); (K.I.); (K.S.); (S.H.); (Y.M.); (D.G.); (Y.N.); (K.T.); (K.F.)
| | - Yosuke Morizawa
- Department of Urology, Nara Medical University, Kashihara 634-8522, Japan; (T.S.); (K.I.); (K.S.); (S.H.); (Y.M.); (D.G.); (Y.N.); (K.T.); (K.F.)
| | - Daisuke Gotoh
- Department of Urology, Nara Medical University, Kashihara 634-8522, Japan; (T.S.); (K.I.); (K.S.); (S.H.); (Y.M.); (D.G.); (Y.N.); (K.T.); (K.F.)
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Kashihara 634-8522, Japan; (T.S.); (K.I.); (K.S.); (S.H.); (Y.M.); (D.G.); (Y.N.); (K.T.); (K.F.)
| | - Kazumasa Torimoto
- Department of Urology, Nara Medical University, Kashihara 634-8522, Japan; (T.S.); (K.I.); (K.S.); (S.H.); (Y.M.); (D.G.); (Y.N.); (K.T.); (K.F.)
| | - Nobumichi Tanaka
- Department of Brachytherapy, Nara Medical University, Kashihara 634-8522, Japan;
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, Kashihara 634-8522, Japan; (T.S.); (K.I.); (K.S.); (S.H.); (Y.M.); (D.G.); (Y.N.); (K.T.); (K.F.)
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