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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. 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 DOI: 10.1111/iju.15411] [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] [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 Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hikari Otsuka
- Department of Urology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Katsuhiro Ito
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takuto Hara
- Department of Urology, Kobe University, Kobe, Japan
| | | | | | - Minoru Kato
- Department of Urology, Osaka Metropolitan University, Osaka, Japan
| | - Sojun Kanamaru
- Department of Urology, Kobe City Nishi-Kobe Medical Center, Kobe, Japan
| | - Koji Inoue
- Department of Urology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Hiroki Ito
- Department of Urology, Yokohama City University, Yokohama, Japan
| | - Atsushi Igarashi
- Department of Urology, Kobe City Medical Center General Hospital, Kobe, Japan
| | | | - Dai Takamatsu
- Department of Urology, Kyushu University, Fukuoka, Japan
| | - Kohei Hashimoto
- Department of Urology, Sapporo Medical University, Sapporo, Japan
| | - Takashige Abe
- Department of Urology, Hokkaido University, Sapporo, Japan
| | - Sei Naito
- Department of Urology, Yamagata University, Tsuruoka, Japan
| | - Yoshiyuki Matsui
- Department of Urology, National Cancer Center Hospital, Tokyo, Japan
| | | | | | - Takashi Kobayashi
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Taguchi S, Kawai T, Nakagawa T, Kume H. Latest evidence on clinical outcomes and prognostic factors of advanced urothelial carcinoma in the era of immune checkpoint inhibitors: a narrative review. Jpn J Clin Oncol 2024; 54:254-264. [PMID: 38109484 DOI: 10.1093/jjco/hyad172] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/25/2023] [Indexed: 12/20/2023] Open
Abstract
The management of advanced (locally advanced or metastatic) urothelial carcinoma has been revolutionized since pembrolizumab was introduced in 2017. Several prognostic factors for advanced urothelial carcinoma treated with pembrolizumab have been reported, including conventional parameters such as performance status and visceral (especially liver) metastasis, laboratory markers such as the neutrophil-to-lymphocyte ratio, sarcopenia, histological/genomic markers such as programmed cell death ligand 1 immunohistochemistry and tumor mutational burden, variant histology, immune-related adverse events, concomitant medications in relation to the gut microbiome, primary tumor site (bladder cancer versus upper tract urothelial carcinoma) and history/combination of radiotherapy. The survival time of advanced urothelial carcinoma has been significantly prolonged (or 'doubled' from 1 to 2 years) after the advent of pembrolizumab, which will be further improved with novel agents such as avelumab and enfortumab vedotin. This review summarizes the latest evidence on clinical outcomes and prognostic factors of advanced urothelial carcinoma in the contemporary era of immune checkpoint inhibitors.
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Affiliation(s)
- Satoru Taguchi
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Taketo Kawai
- Department of Urology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Tohru Nakagawa
- Department of Urology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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