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Ruiz-Bañobre J, Molina-Díaz A, Fernández-Calvo O, Fernández-Núñez N, Medina-Colmenero A, Santomé L, Lázaro-Quintela M, Mateos-González M, García-Cid N, López-López R, Vázquez S, Anido-Herranz U. Rethinking prognostic factors in locally advanced or metastatic urothelial carcinoma in the immune checkpoint blockade era: a multicenter retrospective study. ESMO Open 2021; 6:100090. [PMID: 33740735 PMCID: PMC7980066 DOI: 10.1016/j.esmoop.2021.100090] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/29/2021] [Accepted: 02/21/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Few studies have investigated the safety and efficacy of anti-PD-(L)1 antibodies in metastatic urothelial carcinoma (mUC) in daily clinical practice. Knowledge about the influence of baseline clinical and analytical factors on therapy outcomes is scarce. PATIENTS AND METHODS We conducted a multicenter retrospective study involving 119 previously treated or untreated mUC patients under anti-PD-(L)1 therapy in a real-world scenario. The objectives of this study were to confirm the safety and efficacy of anti-PD-(L)1 monotherapy and to identify pretreatment factors influencing therapy outcomes. In addition, an independent prognostic model for overall survival (OS) was developed and internally validated. RESULTS Median OS was 7.8 months [95% confidence interval (CI), 5.4-10.4], median progression-free survival (PFS) was 2.80 months (95% CI, 2.4-3.4), disease control rate (DCR) was 40% (95% CI, 31-49), and overall response rate (ORR) was 24% (95% CI, 15-31). Presence of peritoneal metastases was associated with poor OS [hazard ratio (HR) = 2.40, 95% CI, 1.08-5.33; P = 0.03]. Use of proton-pump inhibitors (PPI) was associated with poor OS (HR = 1.83, 95% CI, 1.11-3.02; P = 0.02) and PFS (HR = 1.94, 95% CI, 1.22-3.09; P = 0.005), and lower DCR (OR = 0.38, 95% CI, 0.17-0.89; P = 0.03) and ORR (OR = 0.18, 95% CI, 0.02-1.60; P = 0.002). The three risk category prognostic model developed included Eastern Cooperative Oncology Group performance status, PPI use, albumin level, presence of liver metastases, and presence of peritoneal metastases variables and was associated with higher risk of death (HR = 3.00, 95% CI, 1.97-4.56; P = 0.0001). CONCLUSIONS This study confirms anti-PD-(L)1 monotherapy as a safe and effective treatment option in daily clinical practice for mUC patients. It also describes the presence of peritoneal metastases as an independent prognostic factor for OS and underlines the association between PPI use and worse therapeutic outcomes. Finally, it proposes a new easy-to-use risk-assessment model for OS prediction.
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Affiliation(s)
- J Ruiz-Bañobre
- Medical Oncology Department, University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Santiago de Compostela, Spain; Translational Medical Oncology Group (Oncomet), Health Research Institute of Santiago (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), CIBERONC, Santiago de Compostela, Spain.
| | - A Molina-Díaz
- Medical Oncology Department, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - O Fernández-Calvo
- Medical Oncology Department, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - N Fernández-Núñez
- Medical Oncology Department, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - A Medina-Colmenero
- Medical Oncology Department, Centro Oncológico de Galicia, A Coruña, Spain
| | - L Santomé
- Medical Oncology Department, Hospital Povisa, Vigo, Spain
| | - M Lázaro-Quintela
- Medical Oncology Department, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - M Mateos-González
- Medical Oncology Department, University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Santiago de Compostela, Spain; Translational Medical Oncology Group (Oncomet), Health Research Institute of Santiago (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), CIBERONC, Santiago de Compostela, Spain
| | - N García-Cid
- Medical Oncology Department, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - R López-López
- Medical Oncology Department, University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Santiago de Compostela, Spain; Translational Medical Oncology Group (Oncomet), Health Research Institute of Santiago (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), CIBERONC, Santiago de Compostela, Spain
| | - S Vázquez
- Medical Oncology Department, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - U Anido-Herranz
- Medical Oncology Department, University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), Santiago de Compostela, Spain; Translational Medical Oncology Group (Oncomet), Health Research Institute of Santiago (IDIS), University Clinical Hospital of Santiago de Compostela, University of Santiago de Compostela (USC), CIBERONC, Santiago de Compostela, Spain
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Vázquez-Gómez S, Gulín-Dávila J, Iglesias-Santamaría A, Rodríguez-Losada I, Fernández-Núñez N. Successful Alectinib Treatment Administered by Mixing With a Soft Diet in a Patient With Non-Small-Cell Lung Cancer With Severe Dysphagia. Ann Pharmacother 2021; 55:1423-1424. [PMID: 33685249 DOI: 10.1177/10600280211000703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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García-González J, Ruiz-Bañobre J, Afonso-Afonso FJ, Amenedo-Gancedo M, Areses-Manrique MDC, Campos-Balea B, Casal-Rubio J, Fernández-Núñez N, Fírvida Pérez JL, Lázaro-Quintela M, Pérez Parente D, Crama L, Ruiz-Gracia P, Santomé-Couto L, León-Mateos L. PD-(L)1 Inhibitors in Combination with Chemotherapy as First-Line Treatment for Non-Small-Cell Lung Cancer: A Pairwise Meta-Analysis. J Clin Med 2020; 9:E2093. [PMID: 32635291 PMCID: PMC7408884 DOI: 10.3390/jcm9072093] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 06/26/2020] [Accepted: 06/28/2020] [Indexed: 12/11/2022] Open
Abstract
The combination of programmed cell death-1 (PD-1)/programmed death ligand-1 (PD-L1) inhibitors with chemotherapy has emerged as a promising therapeutic option for advanced non-small-cell lung cancer (NSCLC). The aim of this meta-analysis was to evaluate the efficacy of the combined strategy in this setting. For this purpose, we performed a literature search of randomized controlled trials comparing PD-(L)1 inhibitors plus platinum-based chemotherapy versus chemotherapy alone in stage IV NSCLC patients. Seven clinical trials with 4562 patients were included. In the intention-to-treat wildtype population, PD-(L)1 inhibitor plus chemotherapy was significantly associated with improved progression-free survival (PFS) (Hazard ratio (HR) = 0.61, 95% confidence interval (CI): 0.57-0.65, p < 0.001) and overall survival (OS) (HR = 0.76, 95% CI: 0.67-0.86; p < 0.001) compared to chemotherapy. A significantly higher overall response rate (ORR) was also observed with the combined strategy (Odds ratio (OR) = 2.12, 95% CI: 1.70-2.63, p < 0.001). Furthermore, in all the analyzed subgroups, addition of PD-(L)1 inhibitors to chemotherapy significantly improved efficacy endpoints. Specifically, stratification according to PD-L1 expression revealed a benefit across all patients, regardless of their PFS status. In conclusion, PD-(L)1 blockade added to standard platinum-based chemotherapy significantly improved PFS, OS, and ORR in the up-front treatment of advanced NSCLC.
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Affiliation(s)
- Jorge García-González
- Medical Oncology Department, University Clinical Hospital of Santiago de Compostela and Translational Medical Oncology Group (Oncomet), Health Research Institute of Santiago de Compostela (IDIS), CIBERONC, 15706 Santiago de Compostela, Spain
| | - Juan Ruiz-Bañobre
- Medical Oncology Department, University Clinical Hospital of Santiago de Compostela and Translational Medical Oncology Group (Oncomet), Health Research Institute of Santiago de Compostela (IDIS), CIBERONC, 15706 Santiago de Compostela, Spain
| | | | | | | | - Begoña Campos-Balea
- Medical Oncology Department, Hospital Universitario Lucus Augusti, 27003 Lugo, Spain; (B.C.-B.); (N.F.-N.)
| | - Joaquín Casal-Rubio
- Medical Oncology Department, Complexo Hospitalario Universitario de Vigo, 36213 Vigo, Spain; (J.C.-R.); (M.L.-Q.)
| | - Natalia Fernández-Núñez
- Medical Oncology Department, Hospital Universitario Lucus Augusti, 27003 Lugo, Spain; (B.C.-B.); (N.F.-N.)
| | - José Luis Fírvida Pérez
- Medical Oncology Department, Complexo Hospitalario Universitario de Ourense, 32005 Ourense, Spain; (M.d.C.A.-M.); (J.L.F.P.)
| | - Martín Lázaro-Quintela
- Medical Oncology Department, Complexo Hospitalario Universitario de Vigo, 36213 Vigo, Spain; (J.C.-R.); (M.L.-Q.)
| | - Diego Pérez Parente
- Lung Cancer Medical Department, Roche Farma S.A., 28042 Madrid, Spain; (D.P.P.); (L.C.); (P.R.-G.)
| | - Leonardo Crama
- Lung Cancer Medical Department, Roche Farma S.A., 28042 Madrid, Spain; (D.P.P.); (L.C.); (P.R.-G.)
| | - Pedro Ruiz-Gracia
- Lung Cancer Medical Department, Roche Farma S.A., 28042 Madrid, Spain; (D.P.P.); (L.C.); (P.R.-G.)
| | | | - Luis León-Mateos
- Medical Oncology Department, University Clinical Hospital of Santiago de Compostela and Translational Medical Oncology Group (Oncomet), Health Research Institute of Santiago de Compostela (IDIS), CIBERONC, 15706 Santiago de Compostela, Spain
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Ruiz-Bañobre J, Areses-Manrique MC, Mosquera-Martínez J, Cortegoso A, Afonso-Afonso FJ, de Dios-Álvarez N, Fernández-Núñez N, Azpitarte-Raposeiras C, Amenedo M, Santomé L, Fírvida-Pérez JL, García-Campelo R, García-González J, Casal-Rubio J, Vázquez S. Evaluation of the lung immune prognostic index in advanced non-small cell lung cancer patients under nivolumab monotherapy. Transl Lung Cancer Res 2019; 8:1078-1085. [PMID: 32010585 DOI: 10.21037/tlcr.2019.11.07] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The lung immune prognostic index (LIPI) has been proposed as a new categorical blood-based biomarker to select advanced non-small cell lung cancer (NSCLC) patients for anti-programmed cell death-1 (PD-1) or programmed death ligand 1 (PD-L1) therapy. In this study, we investigate for the first time to the best of our knowledge the prognostic and predictive utility of the LIPI in a multicenter nivolumab monotherapy-based cohort. We retrospectively analyzed the influence of the baseline LIPI on overall survival (OS), progression-free survival (PFS), disease control rate (DCR), and overall response rate (ORR) among 153 patients of a cohort of 188 advanced NSCLC patients treated with nivolumab in the second line of therapy or beyond. Worse LIPI was significantly associated with shorter OS in univariate [hazard ratio (HR) =3.12, 95% confidence interval (CI), 2.12-4.60; P<0.0001] and multivariate (HR =3.67, 95% CI, 1.96-6.86; P<0.0001) analyses. Worse LIPI was associated with shorter PFS (HR =1.45, 95% CI, 1.05-2.03; P=0.03), but this correlation did not reach statistical significance in multivariate analysis (HR =1.49, 95% CI, 0.94-2.38; P=0.09). Worse LIPI was associated with lower DCR in univariate [odds ratio (OR) =0.41, 95% CI, 0.24-0.70; P=0.001] and multivariate (OR =0.44, 95% CI, 0.25-0.78; P=0.005) analyses. This study confirms the utility of the LIPI in prognostication and disease control prediction in advanced NSCLC patients treated with nivolumab in the second line of therapy or beyond.
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Affiliation(s)
- Juan Ruiz-Bañobre
- Medical Oncology Department, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain.,Translational Medical Oncology Group (Oncomet), Health Research Institute of Santiago (IDIS), University Clinical Hospital of Santiago de Compostela, CIBERONC, Santiago de Compostela, Spain
| | | | | | - Alexandra Cortegoso
- Translational Medical Oncology Group (Oncomet), Health Research Institute of Santiago (IDIS), University Clinical Hospital of Santiago de Compostela, CIBERONC, Santiago de Compostela, Spain.,Medical Oncology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Noemí de Dios-Álvarez
- Medical Oncology Department, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | | | - Margarita Amenedo
- Medical Oncology Department, Centro Oncológico de Galicia, A Coruña, Spain
| | - Lucía Santomé
- Medical Oncology Department, Hospital Povisa, Vigo, Spain
| | | | - Rosario García-Campelo
- Medical Oncology Department, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Jorge García-González
- Translational Medical Oncology Group (Oncomet), Health Research Institute of Santiago (IDIS), University Clinical Hospital of Santiago de Compostela, CIBERONC, Santiago de Compostela, Spain.,Medical Oncology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Joaquín Casal-Rubio
- Medical Oncology Department, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Sergio Vázquez
- Medical Oncology Department, Hospital Universitario Lucus Augusti, Lugo, Spain
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